For those over 65, Medicare is typically the main funding source for medical benefits. While it includes coverage for hospital stays, doctor appointments and prescription coverage, it doesn’t always cover home care. There are instances however where Medicare will cover home care – we’ll dive into these below!

#1: Short-Term Care

Medicare will cover some home care if it’s planned for a short period of time and related to a medical condition from which the patient is likely to recover. To qualify for Medicare-covered home care, the patient must have recently stayed in the hospital for at least three days and have enrolled in a Medicare-approved home care program within 30 days of the hospital stay.

If the patient meets these requirements, Medicare will pay:

  • 100% of home care costs for the first 20 days
  • A portion of the costs from days 21-100

After day 100, the patient is responsible for all costs.

#2: Doctor Required Care

In addition to short-term care, Medicare might also cover additional care if the patient’s doctor deems it medically necessary. Types of care a doctor might require include: nursing care, physical therapy, speech therapy and medical social services. Medicare may also help cover any equipment expenses for items like wheelchairs or oxygen tanks.

Unlike short-term medical care, there are no time limits on Medicare coverage for these treatments. The caveat to this is that the patients doctor must re-prescribe these services every 60 days and verify that the patient is homebound.

#3: Hospice Care

Medicare will cover home hospice and respite care for patients who have terminal illnesses and aren’t expected to live more than six months. When the patient is in hospice care, they may also qualify for coverage of the doctor required care that we mentioned in the section above. This additional coverage may include: occupational therapy, physical therapy and grief counseling.

When you enroll in Medicare coverage for hospice care, Medicare will stop covering the treatment and drugs that were being used to cure the patient’s illness. The patient or proxy caretaker will need to confirm that they choose hospice care over medical treatment.

If the patient’s care won’t be covered by Medicare, there are other cost-saving avenues the patient and their families can explore like Medicaid programs, long-term care insurance and veteran’s benefits.

To summarize, Medicare may pay for short-term home care, but it won’t pay for long term care. This means Medicare won’t pay for personal care services such as help with bathing or dressing.

If you’re ready to enroll your loved one in a home care program, give our team at RedBud a call today for a personalized home care solution!