Home Health Care and Medicare: How To Avoid Breaking the Bank

Home Health Care and Medicare

Who genuinely likes being told what to do? It’s one thing when you’re a kid; it’s another when it’s your health dictating what you can or cannot do. Across the country, hundreds of thousands of Medicare beneficiaries struggle with chronic illnesses or new afflictions on a daily basis. Sometimes these conditions mean leaving the house becomes a battle of its own. Which begs the question, how can you receive medical attention when your illness makes it so difficult to go to the doctor? Home health care can cost hundreds of thousands of dollars. Can Medicare help cover some of these services? Let’s dive in.

Who Qualifies for Home Health Care Coverage?

When beginning the home health care and Medicare process, it’s firstly important to make sure you’re signed up for your own Medicare plan. You have to be on Part A and/or Part B of Medicare to receive at-home care. If you have any questions about signing up, contact a trusted licensed representative and we can get you started with a plan today. 

To qualify for at-home care and Medicare, you first need to make sure you meet the classifications to be considered “homebound” by the Centers for Medicare and Medicaid Services (CMS) criteria. To be considered homebound in the eyes of CMS, you must:

  • Require the aid of supportive devices like crutches, a cane, a wheelchair, a walker, or the assistance of another person to leave your residence. 
  • Have a classified medical condition that specifically urges you from leaving your home. 
  • Demonstrate normal inability to leave your house, and exiting the residence requires considerable and taxing effort.

After being classified as homebound, you will need to be under the supervision of a doctor. Your doctor will complete and document a visit with you either three months before your at-home benefits start or within the first month of your benefits. This is all to verify that you meet the criteria. 

What is Provided in Home Health Care and Medicare?

Alongside the services typically offered with Part A and Part B of Medicare, like outpatient services at hospitals, Medicare coverage also provides a number of home-care treatments for which you need to be qualified to receive. Though they aren’t authorized to give 24-hour nurse care, Medicare can cover you with part-time or intermittent skilled nursing care alongside physical, occupational, and speech therapy. Medicare also covers health aides that can help you with activities that might be hard to accomplish alone, like going to the bathroom or preparing light meals for you.

Unfortunately, some of the services Medicare isn’t authorized to cover include 24-hour care, meals delivered at home, general homemaker services, and personal care. If you require more care than what can be covered but finances remain a concern, it might be worth looking into Medicaid. Medicare is federally funded for people with lower incomes, so it’s worthwhile to see if they’re better able to meet your needs on a tight budget. 

What Are You Liable For?

While you won’t need to pay for home health care if you’re signed onto Part A or Part B of Medicare, you may be responsible for 20% of the durable medical materials needed for your care. The costs and benefits are a bit different for those with Medicare Advantage plans, so make sure to double-check which specific plan you have. 

Once you’ve got your plan in place, you can contact a licensed representative to see whether or not you fully qualify to receive at-home care coverage. Most importantly, you and your doctor need to certify that this is the necessary path of action. Sooner than you think, your at-home health services will be covered by Medicare, and you won’t have to worry anymore about breaking the bank!


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