As you get older, there may come a time when you require in-home care. You may not be able to leave your home to go to regular doctors appointments and instead need at-home help in the form of equipment, therapy or skilled nursing. While this can be expensive, Medicare does have coverage for many in-home care services. They could help pay for the cost partially or entirely depending on what you need. Search online to discover which in-home services qualify under Medicare.
While Medicare does provide coverage for in-home services, not everyone will qualify for it. Find out which qualifications are in placer for in-home care with an online search.
Dmytro Zinkevych / ShutterstockTo help with your research, here are some services that Medicare covers.
Skilled Nursing
Skilled nursing is when you require nursing or therapy that can only be performed by a professional or technical personnel. It must be considered medically necessary in order to treat, manage, and observe your condition.
There’s an important difference between skilled nursing and custodial care. Custodial care, which is not covered by Medicare if it’s the only care needed, involves helping you complete daily activities like showering, eating, or dressing. On the other hand, skilled nursing care can only be performed by trained professional staff.1
Some examples of skilled nursing professionals include:
- Registered nurses;
- Licensed practical and vocational nurses;
- Physical therapists;
- Occupational therapists;
- Speech-language pathologists, and;
- Audiologists.
Medicare can help pay for your skilled nursing needs. Before that can happen, your doctor must determine that daily skilled care is necessary.
Skilled nursing is covered under Medicare Part A (Hospital Insurance). The breakdown of what you can expect to pay for skilled nursing with Original Medicare is as follows:
- Days 1 to 20: $0 for each benefit period.
- Days 21 to 100: $185.50 coinsurance per day of each benefit period.
- Days 101 and Beyond: All costs.2
Durable Medical Equipment
Seniors may require certain equipment at home for their health. In order to have it covered by Medicare, it must be considered durable medical equipment (DME). This is medically necessary equipment that a doctor prescribes for you to use at home.
There are many different types of DME. For instance, a senior may require a scooter or lift at home in order to get around. Diabetics may need blood sugar meters or blood sugar test strips. Other examples of durable medical equipment includes:
- Continuous passive motion devices;
- Hospital beds;
- Home infusion services;
- Oxygen equipment;
- Canes;
- Crutches;
- Wheelchairs;
- Traction equipment, and;
- Nebulizer and nebulizer medications.
Original Medicare provides coverage for DME. If it’s accepted, you will pay 20 percent of the Medicare-approved amount plus the Part B deductible. You can either rent or buy the equipment depending on your preference.
Not all equipment qualifies as DME. If you’re wondering whether something qualifies as DME, make sure that it meets the following criteria:
- Able to withstand repeated use;
- Used for medical reasons;
- Not usually helpful to someone who isn’t sick or injured;
- Used in your home, and;
- Has a general expected lifetime of at least three years.3
Certain Types of Therapy
You may be unable to physically leave your home for therapy, which is why in-home therapy can be helpful. Medicare can help you pay for these health services as long as you meet certain criteria. They qualify under Medicare’s skilled nursing coverage.
Some therapy services you can receive in-home include:
- Physical therapy;
- Occupational therapy;
- Speech-language pathology services;
- Medical social services;
- Part-time or intermittent home health aide services, and;
- Injectable osteoporosis drugs for women.
In order to qualify, you must be certified as homebound by your doctor. The therapy you receive must be done by a skilled professional and considered an effective way to treat your condition. Ultimately, you should be expected to improve in a predictable amount of time.4
Find Out If You Qualify for In-Home Care
It’s important for seniors to research what each Medicare plan offers for health coverage. That way, you won’t be stuck with a plan that doesn’t meet your needs and requires you to pay additional money out-of-pocket. Furthermore, you will have to be eligible based on Medicare’s qualifications.
According to Medicare Resources, the following conditions must be met in order to be eligible for in-home care:
- The patient is under the care of a doctor who reviews their treatment plan regularly.
- A doctor has certified that the patient needs skilled nursing care or some type of therapy.
- The patient only needs physical, speech, or occupational therapy for a limited time.
- A doctor has certified the patient as homebound.
- The need for skilled nursing is only part-time or intermittent.
- The home health agency used to provide care is Medicare-approved.5
If you’re in need of in-home care, find out if your Medicare plan can help pay for it. Search online to learn more about what’s covered and to determine whether you qualify. You can also speak with a Medicare representative for additional information.