Paying for Home Care – Utilizing your Medicare Benefit

“How much does it cost?” This is one of the first questions people typically have when it comes to utilizing home care services. Divine Home Care accepts all forms of payment, however, I am just going to focus on utilizing your Medicare home health benefit in this post.If you are 65 and older and have Medicare, you may be eligible for home health services to be covered at 100%. Like any type of coverage, certain criteria must be met in order to have services covered. Listed below are the guidelines created by the Centers for Medicare and Medicaid Services (CMS):

  1. You must be under a doctor’s care and the home care services you receive must be established and reviewed by the doctor.
  2. A doctor must certify that you need intermittent skilled care- meaning – you need a nurse, a physical therapist (PT), a speech therapist or an occupational therapist (OT) to see you at home a few times a week, not constant care around the clock.
  3. The home health agency you have chosen to use must be Medicare-certified.
  4. You must be homebound – but this doesn’t mean bed bound. To be homebound means:
  • Leaving your home isn’t recommended.
  • You are unable to leave home without help from another person, special transportation or a wheelchair or walker.
  • Leaving home takes a considerable and taxing effort.

Let’s dig a little deeper into what home health services Medicare covers. (Remember, these services must be necessary for the treatment of your condition in order to be covered.)

  • Skilled Nursing Care: At Divine Home Care, we have RN Case Managers who make visits and oversee all of our client’s care. Skilled nursing care can include teaching you about a special diet you’re on, dressing changes if you have a wound, giving injections and administering IV therapy – all in your own home.
  • Home Health Aides: If the nurse determines you need additional support at home to help with things like bathing, getting dressed or transferring safely from your bed to a chair, they will include a home health aide in your plan of care. Home health aide services are covered as long as you’re receiving skilled care (nursing, PT, OT or Speech).
  • Therapy (PT, OT, Speech): One or all three of these therapists can come to your home if the therapies will help improve your condition.
  • Medical Social Services: If your condition is causing you social or emotional strain, your doctor can refer you to the home health agency’s Social Worker. (Not all home care agencies have this option so be sure to check into that. We do have a Social Worker at DHC.)

As I mentioned before, we accept all forms of payment. This means, if Medicare doesn’t cover some of the services you are wanting or needing, there are other options for you to continue to receive help at home. Please contact us if you have questions about home care and your coverage. This guide published by CMS is also a great resource for your Medicare questions, including what it doesn’t cover. And lastly, home care can be a very affordable option for you or a family member  who needs assistance to remain living at home. Don’t hesitate to talk to your doctor or call us directly to discuss your options.