Medicare Home Health Care Benefits

If you qualify, Medicare will cover your home health benefits entirely, and while under the law there's no limit on the length of time you will be covered, in practice coverage is limited.

Nevertheless, Medicare home health benefits can mean the difference between you or a family member continuing to stay at home, or your health deteriorating until hospital care or nursing home placement become necessary.

You are entitled to Medicare coverage of your home health care if you meet the following requirements:

  • you are confined to your home (meaning that leaving it to receive services would be a "considerable and taxing effort"):
  • your doctor has ordered home health services for you; and
  • at least some element of the services you receive are "skilled" (intermittent skilled nursing care, physical therapy or speech therapy).

What you get: If you need an element of "skilled" care, then you will also be entitled to Medicare coverage of social services, part-time or intermittent home health aide services, and necessary medical supplies and durable medical equipment. You can receive up to 35 hours of services a week, although few beneficiaries actually get this level of service. You are entitled to the same level of services whether you are a member of an HMO or are enrolled in traditional fee-for-service Medicare.

What you pay: Nothing, with the exception of 20 percent of the cost of medical supplies and equipment, which is covered by some Medigap policies.

While the government insists that it has not changed the criteria for who is eligible for home care services, home health agencies have inevitably cut back on services they provide in order to make their own budgets balance.

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