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How to Finance Care at Home

I.           Medicare

A. Home Medical Services

1.          Skilled Nursing Care

2.          Physical Therapy

3.          Occupational Therapy

4.          Speech Pathology

5.          Home Health Aide Services

6.          Medical Social Services

7.          Durable medical equipment can also be offered under the home health benefit

B. Services Not Covered

1.          Housekeeping

2.          Grocery Shopping

3.          Cooking

4.          Transportation

Home Health Services must be “hands on” personal care, i.e., assistance with such tasks as bathing, dressing, feeding and mobility. Light housekeeping tasks may be performed by home health aides only when “incidental to direct patient care”.

C. Eligibility

  1. Home Health Services must be ordered by a physician and provided by a home health agency that participates in the Medicare program.
  2. The Medicare beneficiary must be:

(i)              confined to the home;

(ii)            under a physicians treatment plan;

(iii)           in need of skilled level nursing care or skilled rehabilitation therapy.

D. Definitions

  1. Homebound – If due to a “medical condition” you have a normal inability to leave home except with the assistance of another person or with medical equipment such as a walker or cane.
  2. Skilled Level Care – Care given or supervised by a qualified professional (i.e., registered nurse or physical therapist).

E. Amount/Hours of Care Offered

  1. Part-Time Care – Care provided for fewer than eight (8) hours per day.
  2. Intermittent Care – Care provided less than seven (7) days per week
    The treatment plan must reasonable and medically necessary.

F. Out of Pocket Expenses for Medicare Covered Home Health Services

  1. Medicare covers home visits at 100% (no deductible and no co-insurance amount)
  2. Durable medical equipment is considered a Medicare Part B service for which a 20% co-insurance payment is charged.

II.         MassHealth (Medicaid)  (Please click here for an overview of MassHealth Services)

III.       Massachusetts Home Care Program (Please click here for an overview of the Home Care   Program)

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