Dear Marci,
My mother is being discharged to her home after a stay in a skilled nursing facility. A social worker from the nursing facility is helping her get Medicare-covered home health care. She has Original Medicare. What kinds of services does Medicare cover? Are there services that are not covered?
-Brian (Franklin, TN)
Dear Brian,
Medicare’s home health benefit covers some home health services for people who meet eligibility requirements, including needing skilled care and being homebound. To learn more about these eligibility requirements, click here.
If your mother qualifies for the home health benefit, Medicare covers the following:
- Skilled nursing services: Services performed by or under the supervision of a licensed or certified nurse to treat your injury or illness.
- Services your mother may receive include injections (and teaching her to self-inject), tube feedings, catheter changes, observation and assessment of your condition, management and evaluation of your care plan, and wound care.
- These services are provided up to seven days per week for generally no more than eight hours per day and 28 hours per week. In some circumstances, Medicare can cover up to 35 hours per week.
- Skilled therapy services: Physical, speech, and occupational therapy services that are reasonable and necessary for treating an illness or injury, and performed by or under the supervision of a licensed therapist
- Physical therapy includes gait training, as well as supervision of and training for exercises to regain movement and strength in a body area
- Speech-language pathologyservices include exercises to regain and strengthen speech and language skills.
- Occupational therapy helps you regain the ability to do usual daily activities by yourself, such as eating and putting on clothes.
- Home health aide: Medicare pays in full for an aide if you require skilled care. A home health aide provides personal care services, including help with bathing, toileting, and dressing. Medicare will not pay for an aide if you do not need skilled care in the first place.
- Medical social services: Medicare pays in full for services ordered by your doctor to help you with social and emotional concerns you have related to your illness. This may include counseling or help finding resources in your community.
- Medical supplies: Medicare pays in full for certain medical supplies, such as wound dressings and catheters, when provided by a Medicare-certified home health agency.
- Durable medical equipment (DME):Medicare pays 80% of its approved amount for certain pieces of medical equipment, such as a wheelchair or walker.
Medicare’s home health benefit does not cover all home care services. Services excluded from Medicare coverage include:
- 24-hour per day care at home
- Prescription drugs
- If your mother need prescription drug coverage, she should enroll in a Part D plan or a Medicare Advantage Plan that provides drug coverage.
- Meals delivered to your home
- Housekeeping services, including light housekeeping, laundry, and meal preparation
- Home health aides may perform some housekeeping services when visiting to provide other health-related services. However, aides cannot visit with the sole purpose of performing housekeeping duties.
For people who are terminally ill, Medicare covers some of the above services if the person elects the hospice benefit.
For more information about the services that Medicare covers and for information about home health agencies in your mother’s area, you or your mother can call 1-800-MEDICARE.
-Marci