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What Home Health Care is Covered by Medicare?

Home health care was estimated to cost Americans over $123 billion in 2020 according to research conducted by the Centers for Medicare & Medicaid Services. While Medicare offers many valuable health benefits including home healthcare coverage, not all costs associated with it may be covered entirely; thus it’s important to be aware of what treatments fall under its purview as well as any associated additional fees or extra charges that might occur with such treatments.

Original Medicare (Parts A and B) typically covers the costs associated with skilled nursing services provided in the home by Medicare-certified agencies, provided they adhere to certain guidelines such as conducting an initial comprehensive assessment of each patient’s needs before communicating them to their physician, as well as periodically reassessing those needs. Medicare Part B also typically covers durable medical equipment in the home such as walkers, wheelchairs hospital beds and traction equipment as long as a physician approves it and it fulfills certain criteria.

Medicare Advantage plans, private insurers that contract with Medicare to provide health coverage, must also include home healthcare services within their offerings. Medicare Advantage enrollees generally don’t pay anything extra for these services but must use only providers approved by Medicare and meet other criteria to receive coverage.

Home healthcare services typically cater to those living with chronic, acute or terminal illnesses – including conditions like heart disease, stroke, ALS, Alzheimer’s and Parkinson’s. Treatment or rehabilitative therapies provided through home healthcare may help manage symptoms more effectively while improving function and reducing further care needs.

Skilled nursing services, home health aides and durable medical equipment are all provided through Medicare’s home healthcare program. Furthermore, medical social services may also be provided to address emotional or mental health concerns that stem from one’s illness or condition.

Home health services may be provided to individuals if their doctor certify them as “homebound.” This means leaving the house without assistance would require great effort, and is therefore not advised due to illness or injury. Individuals can still leave for medical treatments or brief trips such as visiting family or attending weddings, however.

Home health service seekers looking for assistance at home should select a Medicare-certified agency such as Royal Oaks Home Care. In addition, it may be advantageous to find one which takes assignment; such an arrangement enables individuals to save money as nonparticipating providers may charge an extra amount beyond Medicare-approved amounts. Medicare beneficiaries can supplement their home health coverage with Medigap insurance which fills in any “gaps” in their coverage provided by traditional Medicare.