Did You Know: When is home care covered?

We get a lot of questions about what and when is home care covered?

Home care is covered by Medicare when a doctor orders a plan of care for necessary services for someone who is homebound because of chronic illness or injury. Someone is considered ‘homebound’ when he or she has trouble leaving home without the help of either a person or medical equipment because of illness or injury.

A patient whose doctor recommends not leaving home because of a medical condition is also considered homebound.

Home care is generally covered under Medicare Part B. But it can be covered through Part A in some cases after you have been in a hospital as an inpatient for at least three days, or a Medicare-covered skilled nursing facility. In that case, Medicare Part A can cover your first 100 days of home care. Part B covers any days beyond 100. But either way, you don’t have any cost-sharing for covered benefits.

The home health agency sends the bills to Medicare, and the agency must tell you if Medicare won’t cover any items or services its workers provide and the related costs you will incur.

People can qualify for additional options with Home & Community-Based Services (HCBS) Waivers Medicaid or ABD Medicaid. States can offer a variety of unlimited services under an HCBS Waiver program. Programs can provide a combination of standard medical services and non-medical services. Standard services include but are not limited to: case management (i.e. supports and service coordination), homemaker, home health aide, personal care, adult day health services, habilitation (both day and residential), and respite care. States can also propose “other” types of services that may assist in diverting and/or transitioning individuals from institutional settings into their homes and community.

You can apply for these services using the Department of Human Services website for your state, click the button below to visit the PA Independent Enrollment Broker (PA IEB) page.

Learn more: https://paieb.com/en