There are many different ways to receive more of your care from your own home. In this blog, we will discuss the services that Medicare covers, how you might access them, and what steps you can take to get started.
First, let’s talk about home health care.
Home health care includes a wide range of health and social services delivered in your home to treat illness or injury. If you qualify for the home health benefit, Medicare covers skilled nursing services, home health aides, and medical social services. It also covers skilled therapy services, such as physical, speech, and occupational therapy. Finally, Medicare’s home health benefit covers certain medical supplies, such as wound dressings and catheters, and certain durable medical equipment, such as a wheelchair or walker.
Your home health care will be covered by Medicare if you meet the following requirements:
1. You are considered homebound. Usually, this means that it is extremely difficult for you to leave your home and you need help doing so, but during the coronavirus public health emergency, the definition of homebound has been broadened. If you are unsure whether or not you meet the homebound requirement, speak with your doctor. Your doctor will be the one to confirm your eligibility.
2. You need skilled nursing services on an intermittent basis, skilled therapy care, or both.
3. You have a face-to-face meeting with a doctor within the 90 days before or the 30 days after you begin receiving care. This meeting can be facilitated by technology such as video conferencing.
4. Your doctor signs a home health certification and approves your plan of care.
5. You receive care from a Medicare-certified home health agency.
Medicare’s home health benefit covers skilled nursing care and home health aide services provided up to seven days per week for no more than eight hours per day and 28 hours per week. In certain cases, you could receive up to 35 hours per week if needed. You can continue to receive home health care for as long as you qualify, but your plan of care must be reviewed and certified by your doctor every 60 days. Your home health care is covered by Medicare even if your condition is chronic or if you are not showing signs of improvement.
If you believe you could benefit from home health care, first speak to your doctor about your eligibility and the services that are medically necessary for you. You can then contact your State Health Insurance Assistance Program (SHIP) for support finding a home health agency near you. Use our online SHIP Locator or call 877-839-2675 (and say “Medicare” when prompted).
Next, what about the telehealth services you’ve been hearing about?
A telehealth service is a full visit with a provider using technology that allows for both audio and video communication. Depending on the situation, you might access telehealth from your home or at a medical facility. Original Medicare usually only covers telehealth in limited situations, like if you require telehealth services due to acute stroke or behavioral health conditions, or if you live in a rural area. During the coronavirus public health emergency, however, Medicare has expanded telehealth services. Medicare covers your hospital and doctors’ office visits, preventive screenings, and other visits via telehealth. Medicare’s standard cost-sharing rules will still apply. If you would like to have your medical appointments via telehealth, ask your doctor if they offer this service. If you have a Medicare Advantage Plan, you should additionally contact your plan to learn about its costs and coverage rules.
You can also consider medical providers who make home visits or provide check-ins.
Medicare covers services you receive from a medical provider who visits your home. It also covers some services that are not provided face-to-face with a provider, such as check-in phone calls and assessments using an online patient portal. Virtual check-ins can be used to assess whether you should go to your provider’s office for an in-person visit. Speak with your provider to learn if they offer any of these covered services.
Finally, check to see if you can have your prescriptions delivered to your home.
Many Medicare Part D Plans and Medicare Advantage Plans may offer a mail order option to deliver your medications to your home. Contact your prescription drug plan to see if this service is available and what rules may apply. You can also ask your pharmacy if it offers a home delivery service for prescription drugs.
Still looking for more help with receiving care at home?
Your SHIP is here for you! You can contact your SHIP for questions regarding home health care, home health agencies, telehealth, and other local resources that could assist you and your care. SHIP counselors are government-funded to provide trusted, unbiased Medicare counseling at no cost to you. (Depending on your state, your SHIP may go by another name.)
Use our online SHIP Locator or call 877-839-2675 (and say “Medicare” when prompted).