Medicare limits home health coverage to those who are homebound and for whom a doctor has prescribed home health care as being medically necessary. Individual insurers have the right to exercise discretion and may offer coverage for things outside of the scope of Medicare’s guidelines.
Home health care can be a valuable service for seniors who require limited medical care such as medication reminders, wound care, injections or IV therapy. The goal of home health care is to maintain a senior’s health and well-being and help them regain their independence, delaying the transition into an assisted living facility. The cost of home health care can be a concern for many families. Fortunately, there is some support available for low-income seniors.
Medicare will cover home health care for homebound seniors if they have been prescribed that care by a medical professional. Care services can include general personal care, however, home health aides may only be used on a part-time basis for no more than eight hours a day and a total of 28 hours per week.
Medicare Advantage may offer more support through its supplemental program, although individual insurers set their own policies to decide what additional coverage to provide.
Medicaid may also offer home health care, where it is medically necessary, for seniors whose income is at or below 133% of the Federal Poverty Line. Home health care is often included in Medicaid Home and Community Based Services waivers. These are managed on a state level, so seniors should check with their state’s providers to confirm what services are included in any available waivers.
Seniors who have private health insurance may find those plans will cover home health care in a limited capacity. Most private plans cover a portion of the cost of skilled in-home care but do not cover non-medical home care at all. For this reason, it’s important to read policy documents carefully and plan ahead when it comes to paying for long-term care for seniors.