Home health services, including home health aide care, are critical Medicare benefits that allow many beneficiaries to remain safely in their home and out of institutions, like skilled nursing facilities. As long as a beneficiary needs part-time or intermittent skilled services (such as nursing, physical therapy, speech-language pathology services, and occupational therapy) and are “homebound”, home health aides can provide Medicare-covered hands-on personal care, including assistance with the activities of daily living for up to 28-35 hours per week.
In order to receive this benefit, a doctor or other health care provider must assess a beneficiary face-to-face to certify that they need home health services and order their care. Subsequently, a Medicare-certified home health agency must provide it.
So why is it so difficult and rare for beneficiaries to receive this care? Especially Medicare-covered home health aide care? The Center for Medicare Advocacy, in the midst of current cases to address this issue, has a fact sheet explaining Medicare home health aide coverage, why it’s challenging to receive one’s full entitled benefits and what to do about it. See the excerpt below:
Challenges to receiving Home Health care
Although Medicare law authorizes coverage of 28-35 hours per week of home health aide care for a wide variety of services, with no time limit as long as eligibility criteria continue to be met, such care is currently almost never available.
Beneficiaries, particularly those with chronic and/or debilitating conditions, are rarely able to find a Medicare-certified agency that will provide the amount or duration of home health aides they require. Home health agencies often tell beneficiaries that Medicare will only cover aides to provide one or two baths per week for a limited amount of time, although there is no basis for this in the law. Many agencies will not provide any home health aide services at all.
Practical Tips
- Discuss the need for home health care and aides with the individual’s treating provider to ensure the necessary services are ordered and included in the Plan of Care.
- If the goal of the services is to maintain the individual’s condition or slow decline, ensure this is stated in the order and Plan of Care.
- Obtain care from a Medicare-certified home health agency as recommended by a trusted provider or by finding Medicare-certified home health agencies that serve the individual’s zip code.
more information
- Read Center for Medicare Advocacy’s full fact sheet: Medicare Coverage for Home Health Aide Care
- See Medicare.gov’s section on Home Health Services
