If your family member needs only assistance with homemaker or personal services, or companion care, Medicare will not cover the cost.
What home care services aren’t covered by Medicare?
Here are some examples of what Medicare doesn’t pay for:
- 24-hour-a-day care at home
- Meals delivered to your home
- Homemaker services, like shopping, cleaning, and laundry
- Custodial or personal care like bathing, dressing, and using the bathroom when this is the only care you need
Who’s eligible for Medicare home health care?
Medicare pays for you to get health care services in your home if you meet certain eligibility criteria and if the services are considered reasonable and necessary for the treatment of your illness or injury.
If you have Medicare, you can use your home health benefits if:
- You’re under the care of a doctor, and you’re getting services under a plan of care established and reviewed regularly by a doctor
- You need, and a doctor certifies that you need, one or more of these:
- Intermittent skilled nursing care (other than drawing blood)
- Physical therapy
- Speech-language pathology services
- Continued occupational therapy
- The home health agency caring for you is approved by Medicare (Medicare certified).
- You’re homebound, and a doctor certifies that you’re homebound. To be homebound means:
- You have trouble leaving your home without help (like using a cane, wheelchair, walker, or crutches; special transportation; or help from another person) because of an illness or injury, or leaving your home isn’t recommended because of your condition.
- You’re normally unable to leave your home, but if you do it requires a major effort.
- As part of your certification of eligibility, a doctor, or certain health care professionals who work with a doctor (like a nurse practitioner), must document that they’ve had a face-to-face encounter with you (like an appointment with your primary care doctor) within required timeframes and that the encounter was related to the reason you need home health care.
Your rights getting home health care with Medicare
In general, as a person with Medicare getting home health care from a Medicare certified home health agency, you’re guaranteed certain rights, including these:
- To get a written notice of your rights before your care starts
- To have your home and property treated with respect
- To be told, in advance, what care you’ll be getting and when your plan of care is going to change
- To participate in your care planning and treatment
- To get written information about your privacy rights and your appeal rights
- To have your personal information kept private
- To get written and verbal information about how much Medicare is expected to pay and how much you’ll have to pay for services
- To make complaints about your care and have the home health agency follow up on them
- To know the phone number of the home health hotline in your state where you can call with complaints or questions about your care
Visit Medicare.gov to learn more about your rights and protections. You can also download the Medicare & Home Health Care official government booklet for more information.
If you or your family member is considering in-home care as part of a plan to age in place, contact Family Matters In-Home Care today for a free consultation. Our team is dedicated to supporting your family and helping older adults enjoy life in the comfort of their own home for as long as possible.
Some of the services offered by Family Matter In-Home Care include: Alzheimer’s & Dementia Care, Bed & Wheelchair Transfer Assistance, Companionship, Housekeeping & Meal Preparation, Personal Care, Recovery Care, and Transportation.