Let’s say you’re recovering from an injury, major illness (such as a stroke or heart attack) or a surgery. If you’re not yet well enough to take care of yourself—but do not need to be in a nursing home or hospital—the best solution is home health care. But home health care isn’t cheap—and it can be tricky to figure out how to qualify for these services. My advice on navigating home health services…
• Understand the lingo. If you use certain health services and/or equipment in your home while you’re “homebound,” this is known as “home health services.” The services may include nurse visits to monitor your vital signs…physical therapy to recover from surgery…and occupational therapy to help you regain skills needed to bathe or get dressed. It may also include medical equipment, such as a walker, hospital bed or portable commode, that you may need to assist in your recovery. Be aware: Custodial services, such as assistance with shopping, cleaning the home or cooking, are often needed by people with Alzheimer’s disease or cancer but are not covered by Medicare if this is the only care needed. These services typically must be purchased out-of-pocket from home-care agencies. Note: Long-term-care insurance policies may cover some of these services.
• Learn if you qualify. Qualifying for home health-care services depends on the type of health insurance you have. Most people who use home health services are on Medicare or Medicaid. (Some private health insurance plans cover these services, but policies vary.) Before such services will be provided, strict qualifications must be met, and your doctor must certify the services. For example, you must be under the care of a doctor who will certify that you are homebound, meaning that you are unable to leave your home to obtain health services on a regular basis (other than for an occasional doctor’s visit…or for church or other religious services). The doctor must sign off on a plan of care, and the care must be provided by a Medicare-approved home health-care agency. For more on the requirements: Consult the Medicare website at Medicare.gov. Search “home health services.” Or call 800-MEDICARE (633-4227) and ask the representative for information on home health-care qualification requirements.
• See how much is covered. For Medicare beneficiaries on traditional Medicare, 100% of approved services will be covered if they are provided by a Medicare-approved home health-care agency. (Ask the agency if it is Medicare-approved or check Medicare.gov.) Medicare will also pay for 80% of all Medicare-approved medical equipment. Home health-care agencies have nurses, therapists (such as physical, occupational or respiratory), social workers and other aides to provide the care in your home. If you are in a Medicare Advantage Plan, you may be limited to certain agencies that are contracted by the particular plan you hold. If you are on Medicaid, all approved costs are covered. Bonus: In all 50 states and the District of Columbia, Medicaid has programs that will allow a family member to be paid to provide some caregiving services to the beneficiary after a caseworker has determined what home services are needed. For details on eligibility, contact your state Medicaid office.