Q: What in-home care will Medicare cover?
A: The in-home care that Medicare will cover depends on the type of care involved, and whether it’s truly medical in nature.
Many seniors require in-home care, but that care isn’t always medical in nature. While Medicare will often pick up the tab for services such as in-home skilled nursing or physical therapy, it generally won’t cover care that’s custodial in nature.
Custodial care refers to supportive care for those who are incapable of managing daily living functions, like dressing, bathing, or preparing food. Medicare will sometimes pay for short-term custodial care (100 days or less) if it’s needed in conjunction with actual in-home medical care prescribed by a doctor. Otherwise, seniors typically need to pay for custodial care themselves.
Other types of in-home care, however, are covered by Medicare, including the following:
Skilled nursing care
Skilled nursing services are generally required to treat an illness or assist in the recovery of an injury. As the name implies, those who provide this care are licensed to administer medical treatment such as injections, catheter changes, wound dressings, and tube feedings.
Medicare will pay for what’s considered intermittent nursing services, meaning that care is provided either fewer than seven days a week, or daily for less than eight hours a day, for up to 21 days. Sometimes, Medicare will extend this window if a doctor can provide a precise estimate on when that care will end.
The maximum amount of weekly care Medicare will pay for is usually 28 hours, though in some circumstances, it will pay for up to 35. But it won’t cover 24-hour-a-day care.
Physical, occupational, and speech therapy
Medicare will pay for physical therapy when it’s required to help patients regain movement or strength following an injury or illness. Similarly, it will pay for occupational therapy to restore functionality and speech pathology to help patients regain the ability to communicate.
However, Medicare will only pay for these services if the patient’s condition is expected to improve in a reasonable, predictable amount of time, and if the patient truly needs a skilled therapist to administer a maintenance program to treat the injury or illness at hand.
Durable medical equipment
Medicare will cover the cost of medically necessary equipment prescribed by a doctor for in-home use. This includes items such as canes or walkers, wheelchairs, blood sugar monitors, nebulizers, oxygen, and hospital beds. Patients typically pay 20 percent of the Medicare-approved amount for such equipment, as well as any remaining deductible under Part B.
Medical social services
Medicare will pay for medically prescribed services that allow patients to cope with the emotional aftermath of an injury or illness. These may include in-home counseling from a licensed therapist or social worker. Medicare will only cover these services for patients receiving skilled nursing care.
Who’s eligible for in-home care through Medicare?
Medicare enrollees are eligible for in-home care under Medicare Parts A and B provided the following conditions are met:
- The patient is under the care of a doctor who reviews his or her treatment plan regularly.
- A doctor has certified that the patient needs skilled nursing care or some type of therapy.
- The patient only needs physical, speech, or occupational therapy for a limited period of time.
- A doctor has certified that the patient is homebound.
- The need for skilled nursing is only part-time or intermittent.
- The home health agency used to provide care is approved by Medicare.
Additionally, other than durable medical care, patients usually don’t pay anything for in-home care.
Many seniors require assistance with activities of daily living, as opposed to an actual medical condition. A long-term care policy can help defray the cost of home health aides whose services are strictly custodial in nature. It can also help pay for assisted living facilities, which offer seniors the ability to live independently, albeit with help.
Maurie Backman has been writing professionally for well over a decade, and her coverage area runs the gamut from healthcare to personal finance to career advice. Much of her writing these days revolves around retirement and its various components and challenges, including healthcare, Medicare, Social Security, and money management.