Medicare Coverage and Exclusions for Home Health Aide Services Explained
In the realm of healthcare, understanding what Medicare covers can be crucial for those in need of assistance. When it comes to home health services, Medicare Part A and Part B offer specific coverage under certain conditions.
Firstly, let's delve into Medicare Part A. This part primarily covers home health care related to a recent hospital stay. It pays for skilled nursing care and rehabilitation therapy at home when ordered by a doctor following an inpatient hospitalization. The care provided is typically intermittent, not full-time, part-time care less than seven days a week and less than eight hours a day, generally up to about 21 days or longer if medically necessary. Part A also covers up to 100 days of skilled nursing facility care after a hospital stay, but it does not cover long-term nursing home care.
On the other hand, Medicare Part B covers home health services for people who are homebound and need intermittent skilled nursing care, physical therapy, speech-language pathology, or continued occupational therapy, but without a recent hospitalization. Part B coverage includes durable medical equipment (DME) like walkers, oxygen tanks, or CPAP machines, as well as medical supplies needed for home treatment. Patients pay the Part B deductible and generally 20% coinsurance. Part B also covers certain outpatient services, but it does not cover nursing home stays; however, it may cover skilled therapy services if the 100-day Part A skilled nursing facility benefit is exhausted.
Key covered home health services under Medicare include skilled nursing care, rehabilitation therapy (physical, occupational, and speech), durable medical equipment, medical supplies, and nursing home stays (for a limited period after a hospital stay under Part A).
It's important to note that all home health services must be provided by a Medicare-certified home health agency and ordered and supervised by a physician. The care must be part-time and medically necessary, often with the patient being homebound or recently hospitalized.
However, Medicare does not cover certain services, such as foot care, regardless of whether they involve home healthcare. It also does not cover 24-hour care in the home, home health personal care aides as a stand-alone service, meal delivery, household services, or personal care (such as bathing) without the need for skilled nursing care.
To qualify for home healthcare under Medicare, an individual must be enrolled in Original Medicare (Part A and Part B), be certified as needing therapy services or intermittent nursing care, receive care from a Medicare-approved agency, and be considered homebound. For Medicare to pay for home healthcare, a Medicare-certified home health agency must provide the service.
In summary, Part A primarily covers home health care related to recent inpatient hospital stays, while Part B covers intermittent home health care for homebound patients without recent hospitalization and durable medical equipment. Both focus on skilled nursing and therapy services rather than long-term custodial care.
- In the context of healthcare, understanding the benefits offered by Medicare Part A is crucial, as it covers home health care specifically related to a recent hospital stay.
- Under Medicare Part B, home health services are provided to patients who are homebound and require intermittent skilled nursing care, but without a recent hospitalization.
- Key services covered by Medicare for home health care include skilled nursing care, rehabilitation therapy, durable medical equipment, and medical supplies.
- Importantly, all home health services must be provided by a Medicare-certified home health agency and ordered and supervised by a physician.
- To qualify for home healthcare under Medicare, an individual must be enrolled in Original Medicare, be certified as needing therapy services or intermittent nursing care, receive care from a Medicare-approved agency, and be considered homebound.
