Medicare In-Home Help

Medicare covers up to three weeks of skilled nursing in-home health care.

The Medicare insurance health plan is offered to eligible participants aged 65 and older or those of any age with serious and permanent disabilities who are not covered by Medicaid. Medicare offers limited insurance coverage for in-home care if the recipient is confined to home rest and in need of home health care.

Medicare Home Health Basics

Medicare recipients who receive a physician's certification that home health care is necessary for the homebound patient can qualify for limited care. Medicare must pre-certify and preapprove the home health care provider. Homebound patients are those who may not leave home without significant effort. These patients include those who rely upon special transportation, wheelchair use or another person to help transport them; or those whose condition is so severe that leaving the home is not recommended. Homebound individuals may leave their homes for short and intermittent reasons that may include non-health care visits.

Limits on In-Home Care

Medicare pays for limited in-home car on a part-time basis. If patients need more than part-time temporary care, defined as nursing care less than seven days weekly or eight hours daily for three weeks, then Medicare does not cover the in-home care. Medicare provides exceptions in a case where a physician can predict the ending date for the in-home care.

Medicare Approved Providers

Medicare pays approved providers of in-home services once during a two-month period or "episode of care." Other services such as doctor's visits to the patient's home are usually covered through Medicare's original coverage, and Medicare may not count the visits toward the in-home care allowance. Typically, in-home nursing care includes skilled nursing care from a licensed practical nurse or registered nurse. Skilled nursing care involves administering tube medication, feedings, changing the patient's dressings and teaching patients and their families about how to manage medical care once the coverage ends. Covered services also include occupational or physical therapy, social services and medical supplies ordered by in-home care providers.

Special Use Equipment

Medicare covers 80 percent of the cost for special medical equipment used at home. To qualify for Medicare coverage, the patient's doctor must order this equipment on the patient's behalf. Equipment includes ambulatory aids, beds and special machines required for the patient's condition.

Exclusions From In-Home Coverage

Medicare does not cover the costs for all-day or 24-hour in-home care, meal services and housecleaning assistance unrelated to the patient's care plan. Patients requiring additional in-home care for an extended period may purchase a special type of Medicare coverage known as Part B that may pay for the extended care and provide services that are more comprehensive.

References

• Centers for Medicare and Medicaid Services: Official U.S. Government Medicare Handbook
• Centers for Medicare and Medicaid Services: Official U.S. Government Home Health Care Benefits Booklet
• Nolo.com: Medigap (Covering the Gaps in Medicare)

Resources

• Medicare.gov: Medicare Part A (Hospital Insurance)