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Understanding Your Coverage: Does Medicare Pay for Home Care?

If you or your elderly parent or relative is in need of home care, you may be wondering if it’s covered under his or her Medicare plan. Our team at WellSprings Home Care Services has the answers right here for you.

Medical and Non-Medical Home Care

To start, let’s define what we mean by medical home care, or home health care, and non-medical home care. These terms share many similarities, but have distinct differences – especially when determined by Medicare standards.

Home health care is provided by a medical professional, such as a nurse or physical therapist. Such practices include nursing care, rehabilitative therapy, medication administration, and so on. Home health care is usually recommended by a doctor, especially right after a surgery or fall in the home.

Non-medical home care is provided by trained caregivers who are not licensed medical professionals. This care can include services such as live-in care, personal hygiene assistance, light house chores, and companionship.

What Type of Home Care Does Medicare Cover?

Medicare covers home health care, and the terms must meet specific criteria, including the following:
• Your doctor has advised medical care at home
• You need medical assistance such as nursing care, physical therapy, occupational therapy, or speech therapy
• You are unable to leave your home without assistance, also known as being homebound
• The homecare agency you’re working with is Medicare-certified

If these four terms are met, your Medicare plan will cover these types of home health care:
• Part-time or intermittent nursing care
• Part-time or intermittent home health aide services
• Physical therapy, speech therapy, and occupational therapy
• Social services such as counseling or community resources
• Some medical supplies, excluding prescription drugs and biological
• Wheelchairs and walkers

Medicare will not cover:
• Live-in care
• Delivered meals
• Personal care assisted by home health aides

In most cases, Medicare will cover the full amount of nursing and therapy services, and 80% of wheelchair and walker expenses. However, you may have to pay a coinsurance amount in some instances.

These same benefits apply if you have a Medicare Advantage plan, except that you will need to obtain services through a home health agency within the plan’s network.

In cases where you need to pay a coinsurance, a Medicare Supplement plan, or Medigap, can help to cover this amount, along with other costs not covered by Medicare Part A or Part B.

Find the Right Home Health Care Agency to Help

Not every home health care agency is certified by Medicare. You’ll want to check on this factor first, before choosing where to hire a home caregiver. Your doctor can help with recommending an agency within your network, or you can visit Medicare.gov to find a Medicare-certified agency in your area.

While Medicare will cover medical expenses within the home, it may be that you or your elderly loved one needs help with everyday tasks. Thankfully, there are several other options when it comes to paying for non-medical home services.

If you are a senior or family member of an aging loved one in the Delaware County, Montgomery County, and Chester County areas, feel free to contact us at WellSprings Home Care with your home care questions and concerns.

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