Does Medicare Cover Home Health Care for Seniors?

Table of contents

• Does Medicare cover home health care?
• Who qualifies for home health care services?
• How does Medicare define homebound?
• Can a Medicare patient receive home health and hospice at the same time?
• How can I get home health care for my senior parent?

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Home health care refers to services given in your senior parent’s home to treat injuries or illnesses. It’s typically more convenient and just as effective as the care you get in a hospital or skilled nursing facility (SNF).

A strong home healthcare team can prevent your senior parent from returning to the hospital, reduce trips to the ER or urgent care, and help them live safely at home for longer.

Medicare does cover home health services for seniors, but there are some rules.  Let’s look at what home health services Medicare will cover and the eligibility requirements.

Does Medicare cover home health care?

Original Medicare covers home health services that meet eligibility criteria. These services include:

• Nurse visits for medication management or wound care
• Physical therapy
• Occupational therapy
• Speech-language therapy
• Medical social services
• Medical supplies ordered by a doctor

Seniors who meet Medicare’s criteria can receive home health care benefits under either Medicare Part A or Part B.

Medicare Part A typically covers costs related to an inpatient hospital stay. If your parent spent at least three consecutive days in a hospital or Medicare-approved SNF, Part A covers their first 100 days of home health care. Your parent must start these services within 14 days of returning home. They do still have to meet the other eligibility criteria discussed below.

After your parent has used the 100 days provided by Part A or if they did not have a qualifying inpatient stay, home health care coverage is provided by Medicare Part B. Any senior with Medicare who meets the eligibility criteria listed below can have home health care covered. There is typically no deductible or coinsurance for Part B-covered home health care.

Non-skilled personal care is not typically covered by Medicare, although it may cover some services if it is part of your parent’s home healthcare plan. This care includes help with bathing, dressing, eating, or chores that most people can do on their own. 

Who qualifies for home health care services?

To qualify for home health services under Medicare, seniors must meet the following criteria:

1. Be considered homebound according to Medicare rules
2. Require skilled care on a part-time or intermittent basis to improve, maintain, or prevent deterioration of a health condition
3. Be under the care of a nurse practitioner, clinical nurse specialist, physician’s assistant, or doctor who completes and documents an in-person visit either:
   1. Within three months before home care starts
   2. Within one month after home care starts
4. Receive home health care services from a Medicare-approved home health agency

Medicare defines part-time or intermittent care as care that’s needed fewer than seven days a week or less than eight hours a day for up to 21 days. The three weeks can be extended if your parent’s doctor documents why it’s still needed and has a good idea of when you will no longer need skilled care.

Seniors typically aren’t eligible for Medicare home health care benefits if they need full-time skilled nursing care for an extended period. There may be other types of coverage for full-time care.

Your parent’s healthcare provider and the home health team should review and recertify your parent’s plan of care at least once every 60 days.

How does Medicare define homebound?

The term “homebound” may sound restrictive and conjure up images of an elderly shut-in who never leaves the house. However, the Medicare definition of homebound isn’t nearly so extreme. 

According to Medicare, a senior is considered homebound when they meet at least one of the following:

1. They need the help of another person or medical equipment such as crutches, a walker, or a wheelchair to leave the house due to their illness or injury. 
2. Your parent’s doctor believes their health or illness could worsen if they leave the house.

Seniors who are considered homebound by Medicare are still allowed to leave the house to attend: 

• Medical appointments
• Religious services
• Licensed adult daycare services
• Funerals
• Family reunions
• Graduations
• Occasional trips to the barber or beauty parlor 

Some examples of seniors who would typically be considered homebound by Medicare include:

• A person who had a stroke and now needs a wheelchair or crutches to get around
• A person who was weakened by illness, surgery, or an extended inpatient stay
• A person who has severely impaired vision and needs help to get around
• A person with cognitive dysfunction or dementia who gets anxious or confused easily
• A person with severe heart or lung disease who must avoid stress or physical activity

Your parent’s doctor is the one who certifies if they meet the Medicare definition of homebound.

Can a Medicare patient receive home health and hospice at the same time?

The Medicare hospice benefit covers a range of services intended to provide medical, emotional, and spiritual support to individuals with terminal illnesses. These could include:

• Medication management 
• Medical supplies
• Social work services
• Some assistance with bathing and toileting
• Doctors and nurses who specialize in hospice

Hospice is designed to improve quality at the end of life. It is not for people still trying to cure their illnesses. Usually, patients in hospice don’t meet the requirements for home health services. There are some exceptions, though.

In very limited circumstances, Medicare will cover some home health such as physical therapy, occupational therapy, or speech therapy for hospice patients. This is usually if the therapy will help improve the patient’s quality of life. 

For example, a short course of physical therapy that helps the patient be safer while ambulating to the bathroom might be covered. 

How can I get home health care for my senior parent?

Parentis Health makes it easy for your senior parent to get high-quality medical care in the comfort of their home. 

Whether they’re recovering after a hospital stay, navigating a change in health, or managing a chronic health condition, we can provide the home healthcare services your parent needs in a few simple steps.

1. Ask your parent’s doctor for a referral to Parentis Health.
2. We review your eligibility and get insurance authorization.
3. Once confirmed, we’ll schedule a meeting within 24-48 hours to assess your parent’s needs.
4. Following the assessment, we’ll schedule your parent’s home healthcare services.

Medicare home health services are 100% covered for patients who meet their criteria.

Contact us today to learn more!