Is In-home Care Medicare Covered?

Posted: 9/3/2020 8:00 AM by Interim HealthCare

Over 44 million Americans are currently on Medicare. And that number is expected to increase substantially in the next decade -- up to 79 million by 2030.

With so many seniors relying on Medicare to help them stay happy and healthy, it's unsurprising that we are often asked whether in-home care is covered by Medicare. After all, you want to know that your older loved ones can enjoy good health without worrying about high out-of-pocket costs!

The answer is often yes...but it's not quite as cut and dry as you might hope.

If you or a loved one has been using Medicare for any time, you've probably learned that it doesn't quite cover everything you or your loved one may need to maintain good health. At least not 100%. That's why many seniors rely on Medicare supplemental insurance to provide additional coverage. 

But in many instances, Medicare does provide some important conveage. And that includes in-home health care.


Paying for In-Home Health Care: An Introduction

There are three (3) options seniors and their families use to pay for home health care services:

1. Self pay

This is exactly as described -- paying out of pocket for in-home care services. This fee is either set or negotiated by your in-home care provider, and can depend on variables like services needed, length/duration of care, and more. 

2. Private Third-Party Payers

In other words -- any non-Medicare or -Medicaid health insurance, from a private company. Think companies like Blue Cross Blue Shield and so many others, which can vary based on your location. 

Many private health insurance plans will cover some home health care services for people with acute medical needs. If long-term care is included with your plan, it may also pay for in-home health care services. 

There is often some level of cost sharing involved with private insurance, which means that your family should expect to pay at least something out of pocket if you're relying on private insurance.

There is sometimes additional assistance available through programs like the Veterans Administration and other resources provided by the Older Americans Act (OAA) of 1965. It's important to talk to your local Interim HealthCare office to determine which programs and assistance are available to you -- we want to help make in-home care as affordable and accessible to you and your loved ones as possible!

3. Public Programs

Since we're discussing Medicare in this post, let's dig right into the circumstances where in-home health care is covered by Medicare. There are some specific conditions required for in-home care that's Medicare covered:
  • You or your senior loved one must be an eligible Medicare beneficiary
  • A physician must certify the need for services and have an established plan of care
  • You or your loved one must meet Medicare's definition of "homebound"
  • Any in-home care must be provided in your or your loved one's place of residence
  • You or your loved one must require skilled nursing on an intermittent basis, must need physical or speech therapy, or must have a continued need for occupational therapy
  • Any in-home health care services must be provided by a Medicare-certified home health agency (HINT: This includes most Interim HealthCare locations -- contact your nearest location to learn more!)
Once these criteria are met, there are some other in-care services that may be available. It's important to speak with your or your loved one's doctor to determine the best course of action, and to learn what can be covered by Medicare. 

 

We'll help you find the best in-home care payment options to meet your needs.

Whatever course of care your or your loved one's doctor recommends, Interim HealthCare is here to provide you with the in-home care and support needed to stay happy and healthy at home. To learn more about the in-home health care services and payment options available near you, contact your nearest Interim HealthCare location.