I am frequently asked whether home care services are covered by HMO insurance plans or Medicare. Medicare home health services are a great benefit to older adults who qualify for Medicare coverage. Home health is a skilled care benefit. What does that mean? A licensed physician must order home health services and they must perform a face-to-face encounter to assess your homebound status.

Typically, acute care episodes will trigger this event. For instance, a stroke is a medical condition that could qualify. One would likely be homebound due to that medical condition and it would be a taxing effort to leave home. Additionally, a physician may recommend that you need Home Health to prevent an acute care episode. These two conditions would qualify for a home health services order.

Homebound is a result of the medical condition that prevents you from leaving home without it being a taxing effort. For example, using a wheelchair, a walker, or a cane or needing the assistance of another person to assist with leaving home would qualify as a taxing effort. Below, I found this article that defines those home health services Medicare pays for:

“The home health benefit provided by Medicare (and many other payers) encompasses a wide range of services that can be delivered in a patient’s home, including injections, post-operative and chronic wound care, rehabilitation, physical therapy, intravenous or nutrition therapy, etc. These types of services can be a life-line for vulnerable patients, including the Medicare population that is both at increased risk of developing serious complications from Covid-19, and more likely to suffer from chronic comorbidities — a potentially deadly combination.” (Forbes Seth Joseph, Aug 5, 2020) https://www.forbes.com/sites/sethjoseph/2020/08/05/home-health-care-is-a-bright-light-during-covid-19-with-an-even-brighter-future/?sh=340378f71389

Home care is different. It is non-skilled care that is provided by a caregiver. Home care is a choice one makes by hiring a company or a caregiver to come into their home to help with Activities of Daily Living (ADL’s). These include bathing, dressing, laundry, meal preparation, medication reminders, errands, housekeeping, pet care, assistance with transfers, assistance with ambulation or other activity that is difficult but necessary to stay safe at home. Non-skilled services are paid from private funds, long term care insurance, workers compensation policies, and Medicaid. Some HMO plans are starting to pay for this service, but it seems they are limited in the amount of care they are willing to provide, and it may depend on your policy.

We have found through our own internal investigation is that combining Home Care with Home Health, readmissions can drop from 12% down to approximately 3%. It is our opinion that you are much safer at home by adding home care in combination with home health. Caregivers will report change in health condition, help prevent unnecessary falls, provide reminders to take medications and help keep living spaces clean and free from obstacles that can cause a fall. Please call Sunlife Home Care with any questions at: 214-326-3872.  

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