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How To Check If My Loved One Qualifies For Home Health Care Medicare

As our loved ones age, they may prefer to continue living in their homes even with some debilitating health conditions or injuries. Most people want to age from the comfort of their homes, surrounded by their loved ones and in a familiar environment. Although you might want your loved one to move in with you, there might be better solutions than this, as you may have family and work commitments that make it difficult to concentrate fully on a loved one’s health.

Additionally, most aging parents do not wish to impose on their kids (even if this is not true). Having your loved one age from the comfort of their homes is advantageous as they can receive the care they require at home.

Home health care for seniors provides an easy solution as your loved one will stay in the comfort of their homes with a caregiver providing the required oversight.

When your loved one with some medical condition decides to age from the comfort of their home, you can look into home healthcare Medicare. Medicare will cover seniors’ home health services they will receive during a 30-day care period depending on your loved one’s medical condition and needs.

a happy senior enjoying herself with staff from medicare home health care agencies

What’s Home Health Care?

Home health care is the wide range of services your aging loved one can access for recovery from injury or chronic illnesses from the comfort of their homes. These services are usually more convenient, less expensive, and practical as if your loved one obtains them from a hospital.

Some of the services covered under home health care include

  • Surgical wound care
  • Caregiver and patient care education
  • Nutrition therapy
  • Intravenous therapy
  • Injections
  • Monitoring of severe or unstable illness.

The primary goal of these services is the treatment of a chronic illness or injury to help your loved one

  • Regain their independence,
  • Recover,
  • maintain their current level of function and condition,
  • Become self-sufficient as much as possible, and
  • Slow the decline of their medical condition.

an older man receiving an injection in the privacy of his home - Medicare home health care


Eligibility Criteria For Medicare Home Health Care

When you or your loved one decides to receive health care from the comfort of home, you may wonder if they can receive Medicare home health care coverage. Your loved ones’ doctor will decide if they are eligible for Medicare home health care coverage. However, it will be easier to understand the process when you know Medicare home health criteria and coverage.

To be eligible for Medicare home health care benefits, your loved one must meet the following health requirements:

Doctor Orders Home Health Care For Them

Your doctor will evaluate your needs to determine if they meet home healthcare eligibility criteria. Some of the signs that indicate that a senior is eligible for home health care include:

  • New Diagnosis
  • Worsening symptoms of an existing condition
  • New or change of medication
  • Frequent hospital visits

Senior man asking if he can get home health care with Medicare

When your loved one is Confined to Their Home (Homebound)

Another criterion is to meet Medicare’s Homebound criteria, which means your loved one finds it difficult to leave their home and needs help. Your loved one’s doctor will evaluate their health and decide if they meet this criterion. A doctor will certify that your loved one meets Medicare’s homebound criteria when they:

  • Need the help of a mobility-supportive device like a walker, cane, or wheelchair.
  • They need the help of another person to get out of their home.
  • When their doctor believes your loved one’s condition could worsen if they leave home
  • If your loved one doesn’t leave home often
  • It takes a great deal of effort for your loved one to leave home.
  • If your loved one leaves home, visits the barber for a haircut, visits a beauty parlor, goes to adult daycare, attends a religious service, or an important event like graduation, wedding, family reunion, or funeral.


Your Loved One Receives Care From A Medicare-Certified Agency

Before your loved one can receive care services from an agency, find out if it is Medicare-certified, as this will make it easier for your loved one to qualify for home health care services. An agency has to meet federal requirements before it can be Medicare-certified. To find an ideal home healthcare agency certified by Medicare, you can use the Care Compare tool provided by the Centers for Medicare and Medicaid Services (CMS).


How Does Home Health Care Medicare Eligibility Work?

Home health care Medicare benefits can prove tricky to understand. The following examples are real-life scenarios that would help you understand how it would work for your loved one:

Example 1:

Jason fell down the stairs and needed hip surgery. After spending a week in the hospital, the hospital is ready to discharge him, but he isn’t fully healed. Jason’s doctor includes information about Jason being homebound in the discharge paperwork and, therefore, needs short-term skilled home health care. His doctor then lists information on the services and equipment Jason will require, ensuring Jason is eligible for home health care.

Example 2:

Sally has Amyotrophic Lateral Sclerosis (ALS), and her balance is getting worse. She has started using a walker to move around her home. It takes her hours to prepare for the day. By the time she’s done, she’s too tired to do anything else. She leaves her home to keep her medical appointments, and family reunions, attend church, and sometimes go to her bi-weekly local support group.

For her safety, she needs constant help, but her daughter works most of the time and can only assist several hours weekly. On her recent visit to the hospital, her doctor offered home health care, which will include physical and occupational therapy, home health aide, and skilled nursing. In this case, Sally meets home health care Medicare eligibility criteria.


Services Covered by Medicare For Home Health Care

After your loved ones’ doctor orders home health care, a home health agent will schedule an appointment and visit them to discuss their needs and ask questions regarding their medical condition requirements. A home healthcare agency employee will talk with your healthcare provider about your loved one’s condition and progress.

Some of the services that a home health agent should look out for when they visit your loved one are:

  • Check if your loved one is eating and drinking.
  • Check if the senior is taking their prescription correctly.
  • Ask if your loved one is in pain.
  • Check your loved one’s blood pressure and breathing, heart rate and temperature
  • Check for home safety.
  • Teach senior care tips to ensure they can care for themselves.
  • Coordinate with your loved ones’ healthcare providers about their care routine.

This means a home healthcare agent must regularly communicate with your loved one, their doctor, and anyone caring for them.

A senior couple discussing with their doctor if they are eligible for Medicare home health care

Differentiating Between Home Health Care and Custodial Care


Home Health Care (HHC)

If your loved one is homebound, they may receive different medical services from HHC from the comfort of their home. Once a person qualifies for HHC, their doctor lists all the services they will require for their recovery plan. When your loved one receives HHC, it doesn’t matter if they have a terminal condition or one that will improve with time. Therefore, this makes HHC an ideal fit for a wide range of patient needs. Some of the HHC services include

  • Skilled nursing care
  • Medical equipment supplies like oxygen, hospital beds, wheelchairs or walkers,
  • Rehabilitative therapies
  • Home health aides.


Custodial Care

This type of care is a great way to care for your elderly loved one, but in this case, a non-skilled person provides the care. A custodial caregiver doesn’t need to be a health care professional and usually provides essential assistance with activities of daily living (ADLs) such as bathing, toileting, meal preparations, and helping with light housekeeping.

They may also receive medical assistance with medication management, like using eye drops or taking pills, but no help with advanced medical procedures.

Medicare-approved Home Health Care Agencies

After checking on your loved one’s eligibility for home healthcare medicare services, the next step is finding an ideal Medicare-approved home healthcare agency near you. The Medicare interactive search engine will help you find Medicare-approved agencies nearby. This site contains information such as the agency’s contact details, which services the agency offers, and patient ratings.

Medicare search engine allows you to find their certified agencies. You or your loved one can perform an online search independently without the inconvenience of visiting each agency.

an empty nursing home room ready for a patient to move in

Factors To Consider When Choosing a Medicare-approved Agency

  1. Medicare certification
  2. Staff credentials
  3. Specialized home health care services
  4. Quality scores
  5. Agency reputation
  6. Patient rating
  7. Costs (if you can obtain a cost breakdown, all the better)
  8. Round-the-clock availability
  9. Accreditation
  10. Smooth healthcare transition
  11. Do they offer personalized care plans?

Insurance Coverage for Home Health Care

Home health care insurance covers various services, ensuring it meets your loved ones’ needs. With this cover, your loved one will easily access physical therapy, skilled nursing care, and other medical care services. You must understand what Medicare will cover when looking for a home health insurance provider.

Before proceeding, it is essential to note that home health care Medicare may cover some medical illnesses and conditions not covered by some private insurance policies under post-hospitalization care and treatment.

For example, Andrew is suffering from a chronic backache. He is advised to go for physiotherapy, and he opts for home health care. If his insurance policy does not cover physiotherapy services, he must pay out of pocket. However, if his doctor advises him to go for physiotherapy after his surgery and includes it on the discharge paperwork, the same policy must cover the services.

an insurance agent explaining what Medicare covers for home health care to an older man at his home

Private Insurance Coverage for Home Health Care

Private insurance may cover skilled, medically necessary home health services, albeit for the short term. However, if your loved one requires non-medical or long-term care, they will likely require a specific insurance cover.

Insurance coverage varies with different plans, and sometimes, your loved one may have to copay in some situations. Before deciding on a specific cover, ensure you and your loved one review the insurance coverage and its benefits for information regarding their available services.

The Role of Medicare in Insurance Coverage for Home Health Care

Medicare insurance coverage for home healthcare beneficiaries is an essential resource for most seniors. If appropriately implemented, Medicare home health insurance covers skilled and unskilled services. The law makes Medicare coverage available to people with chronic or severe medical conditions. It helps them access services that help maintain, improve, or slow down the decline of their medical condition.

Medicare home health care plays a vital role in ensuring your loved one obtains quality medical services when they need it

Medicaid and Home Health Care

If you are wondering whether Medicaid can cover your aging loved one’s home care, then the answer is Yes. However, to understand how Medicaid benefits work for home care, you need to understand how Medicaid works.

Medicaid receives funds from both the state and federal governments. Due to its funding source, the rule governing Medicaid comes from both sources of its funds, with the federal government setting specific rules and giving each state flexibility on the type of services they provide.

Another complication in understanding Medicaid home health care benefits is that each state has different Medicaid programs.


Types of Home Care Services Covered By Medicaid

  1. Home health care
  2. Personal or home care
  3. Caregiver and family support
  4. Homemaker services
  5. Nutrition services
  6. Home Accessibility Modifications
  7. Medical supplies and equipment
  8. Transportation assistance services
  9. Personal Emergency Response Services
  10. Adult Day Cares
  11. Hospice care

Differences between Medicare and Medicaid coverage for home health care

Type Medicare Medicaid
Eligibility a person living with a disability or over 65 low-income earners
Coverage hospital, medications, and doctors Doctors, hospital, medication, and some added benefits
Coverage variation depends on your loved ones plan depends on a senior’s state of residence
Cost depend on the selected plan depend on your loved one’s income level
Funding federal government state and federal governments
Coverage It is made up of several parts, and each part provides different coverage. Provides comprehensive coverage over a wide range of hospitalization, medical, and prescription drug needs.


Having your loved one age from the comfort of their home can be one of the best decisions they can make. But this comes with its set of challenges, especially if your loved one is struggling with a chronic illness or mobility issues.

Looking into home health care is one way of ensuring your loved one’s health comes first. You can consult your loved ones’ doctor about Medicare home health care eligibility when you realize they may need external care.

Home health Medicare allows and pays for your loved one to receive adequate short-term care from the comfort of home. You must research home healthcare agencies near you to facilitate easy care for your loved one.

Taking proactive steps in your loved ones’ care plan ensures their golden years are more comfortable and safe, and they have someone watching the progress of their medical condition.

At Amy’s Eden, we encourage you to talk with your loved one’s doctor about home health care and then research agencies near your loved one’s home. If you want a helping hand with caring for your loved one, don’t hesitate to call us today, and we will be happy to assist you.

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