Basics of Home Health Care

Medicare Part A and Part B provide for some services outside of a hospital or your doctor’s office, such as a skilled nursing home. We will focus on one of those services: home health care.

What is home health care? Home health care provides services for patients who do not require care from highly trained nurses and doctors in the skilled nursing facility or hospital setting. They may, however, require part-time care, physical therapy, or other services such as bathing, cleaning, cooking etc. Home health care agencies are a cheaper alternative.

What are the requirements? First, you must be under the care of a doctor who recommends and designs a home health care plan. He must also review it from time to time. He must also certify that you need some type of therapy (e.g. physical or occupational therapy) and that you need periodic skilled nursing care.

Second, you must select a home health care agency that is certified by Medicare. You can get a list of those at this website. Finally, you must actually be home bound. If you’re capable of leaving your house to receive care than home health care is not medically necessary for you.

How much will Medicare pay? Both Medicare Part A and Part B will cover 100% of home health care. Part A, however, requires that prior to receiving home health care you had to have been in the hospital for three days (not including the day that you left the hospital). Part B will pay 100% as well but only if it meets the requirements listed above. There are some things not covered by Medicare.

It will not cover 24-hour care. If you need 24-hour care then you need to be in a high-level care facility, such as a skilled nursing facility. It will also not cover what Medicare calls “custodial services” such as shopping, cleaning, and laundry and personal care given by home health aides like bathing, dressing, and using the bathroom, when it is the only care you need or these services are unrelated to your plan of care.

Home Health Care Strategies. Home health care does have strategic uses, especially with part A coverage. As mentioned in another post, Part A hospital insurance will only cover the costs for up to 90 days. All covered services will be paid for during the first 60 days. From 61-90 days you will be required to pay a daily coinsurance. This can be extremely expensive. In 2011 the coinsurance amount was $283 per day. If you stayed in the hospital for 29 more days you’d have a bill $8,207. This 90 day period is called a “benefits period”. Every day you’re in the hospital will be counted as one benefit period unless your hospital stays are separated by 60 days. For example, if you spent 3 months in the hospital, left for two months, and then had another hospital stay it would be considered two different benefit periods. You can use home health care to break up hospital stays and prevent having to pay the coinsurance, or worse, the entire hospital bill.

Home health care is cheaper and helps you get back home and with your family sooner. This can ultimately help you recover in a comfortable environment. When planning your hospital stays or talking with your doctor you may want to consider home health care as an option.

You can get further information from the Medicare.gov website