Frequently Asked Questions about Skilled Home Health Care
Most people want to stay in their home for as long as possible. Home health care enables people to recover and maintain their independence after an illness accident or injury. But what if you're caring for a loved one who just needs a little extra help? Our FAQ addresses payment options, eligibility and how skilled home health care differs from personal care.
Is skilled home health care covered by Medicare or other insurance plans?
Home health care ordered by a doctor is typically covered by Medicare, Medicare Advantage and other private insurance plans. Medicare Advantage and private plans may require people to use a provider who is in their network.
Medicare does not cover non-medical senior care or personal care when it is the only care required by a patient. Long-term care insurance may cover some of the cost of in-home senior care services. Veterans and their spouses may be able to use VA Aid and Attendance benefits to pay for home health care.
How do I learn more about Medicare-certified providers and eligibility?
Medicare publishes the Medicare & Home Health Care Guide as a downloadable document. It includes detailed information about:
- Eligibility
- Covered services
- Comparing home health agencies
- Your Medicare rights
What is the difference between skilled home health care and in-home personal care?
Skilled home health care is medical care provided by licensed nurses, nurse aides or therapists. Support usually begins with a prescription from a doctor.
Home health visits can include medical assessments, wound care, IV therapy and physical therapy. Nurses and aides can also maintain, or help you learn how to maintain, feeding tubes, colostomy bags, oxygen and other medical equipment. Visits can include fall prevention, education and strategies to help older adults recover, stay independent and reduce unplanned hospital visits.
Companion care or senior care is non-medical assistance at home. Sometimes older adult just need a little extra help getting up in the morning, personal hygiene, household chores, or transportation to stay independent.
In most states, personal care aides can remind someone to take medications or help them self-administer medicines. They are typically not allowed to administer oral or injectable medications. Some states enable personal care aides with advanced training to administer medications.
Is home care only available in a private home?
Home health care can be provided wherever a person calls home. Agencies can customize support to specific needs at home, a senior living community or even in the home of a friend or relative.
What is the homebound requirement?
Medicare requires people to be homebound to receive home health benefits. Homebound status based on a doctor's evaluation. Homebound does not mean you cannot leave your home for any reason. Homebound patients may leave for:
- Medical treatment
- Religious services
- Licensed adult daycare services
- Family reunions, funerals or graduations
- Occasional visits to a barber shop or beauty parlor
Requirements for homebound status
Because of an illness or injury, a patient needs the help of another person, crutches, a walker, a wheelchair, or special transportation to leave home.
or
There is a normal inability to leave home and leaving would require considerable and taxing effort. Read more about homebound status at https://www.medicare.gov/coverage/home-health-services
How often will the home health team visit?
Your doctor will create a plan of care along with you and the home health provider. The frequency of visits adapts to your needs over time.
Is home health care only available after a hospital visit?
No, people may receive a referral from a doctor, including a primary care doctor or specialist.