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Criteria must be met for Medicare home health care

Dear Savvy Senior: How does Medicare cover in-home health care? My husband has a chronic health condition that makes it very difficult for him to leave the house, so I’m wondering whether he could qualify for Medicare home health care. — Seeking Help

Dear Seeking: Medicare covers a wide variety of part-time or intermittent in-home health care services to beneficiaries in need, if they meet Medicare’s criteria. Here’s how it works.

In order for your husband to secure coverage for home health care, Medicare first requires that he be homebound. This means that it is extremely difficult for him to leave home and that he needs help doing so either from another person or a medical device like a cane, wheelchair, walker or crutches.

If so, he will need to have a face-to-face meeting with his doctor to get a home health certification confirming that he needs skilled- nursing care or skilled- therapy services from a physical or speech therapist on a part-time basis.

His doctor can also request the services of an occupational therapist and a personal care aide to assist with activities of daily living such as bathing, dressing and using the bathroom. His doctor must renew and certify his home health plan every 60 days.

He will also need to use a home health agency that is certified by Medicare.

If he meets all of the requirements, Medicare should pay for his in-home health care.

But be aware that Medicare will not pay for personal care aide services (for bathing, dressing, using the bathroom, etc.) alone if he does not need skilled-­nursing or skilled-therapy services, too. Homemaker services, such as shopping, meal preparation and cleaning, are not covered.

If your husband has original Medicare, you can locate a Medicare-certified home health agency by calling 800-633-4227 or by visiting Medicare.gov/care-compare. If he has a Medicare Advantage plan, contact his plan directly and ask which home health agencies work with the plan and are within the plan’s network of providers.

For more detailed information on how Medicare covers in-home health, see the “Medicare and Home Health Care” online booklet at 808ne.ws/homecare.

Other options

If your husband does not qualify for Medicare home health care coverage, there are various other coverage options depending on your situation. Here are several that might apply to you:

>> Insurance: If you have long-term care insurance, check whether it covers in-home care. Or if you have a life insurance policy, see if it can be used to pay for care.

>> Medicaid: If your income is low, your husband might qualify for Medicaid, which offers different home and community-based serv­ices that can pay for in-home care. To investigate this, contact your local Medicaid office.

>> Also see whether PACE (“Programs of All-Inclusive Care for the Elderly”) is available in your area (see NPAonline.org). PACE provides in-home care, including help with daily-living activities such as meals, dental and medical care, among other benefits.

>> Veterans benefits: If your husband is a veteran, the VA also offers some benefits that can help. Two programs to inquire about are “Aid and Attendance or Housebound Allowances” and the “Veteran-Directed Care” program. Both programs provide monthly financial benefits to eligible veterans that can help pay for in-home care. To learn more, contact your regional VA benefit office (call 800-827-1000 or go to Benefits.va.gov/benefits/offices.asp).

To look for these and other programs in your area that can help pay for your husband’s home care, go to PayingForSeniorCare.com and click on “Find Financial Assistance for Care” to access its Eldercare Financial Assistance Locator tool.


Jim Miller is a contributor to NBC-TV’s “Today” program and author of “The Savvy Senior.” Send your questions to Savvy Senior, P.O. Box 5443, Norman, OK 73070; or visit savvysenior.org.


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