In order for your husband to secure coverage for home health care, Medicare first requires that he be homebound. This means it must be extremely difficult for him to leave home, and he needs help doing so either from another person or medical device like a cane, wheelchair, walker or crutches.
He will then need to have a face-to-face meeting with his doctor to get a home health certification confirming he needs skilled-nursing care or skilled-therapy services from a physical or speech therapist on a part-time basis.
His doctor can also request the services of an occupational therapist and a personal care aide to assist with activities of daily living such as bathing, dressing and using the bathroom. His doctor must renew and certify his home health plan every 60 days.
He will also need to use a home health agency certified by Medicare.
If he meets all of the requirements, Medicare should pay for his in-home health care.
Be aware that Medicare will not pay for personal care aide services (for bathing, dressing, using the bathroom, etc.) alone if he does not need skilled-nursing or skilled-therapy services, too. Homemaker services, such as shopping, meal preparation and cleaning, are not covered.
If your husband has original Medicare, you can locate a Medicare-certified home health agency by calling 800-633-4227 or by visiting Medicare.gov/care-compare. If he has a Medicare Advantage plan, you should contact his plan directly and ask which home health agencies work with the plan and are within the plan’s network.
For detailed information on how Medicare covers in-home health, see the “Medicare and Home Health Care” online booklet atMedicare.gov/Pubs/pdf/10969-Medicare-and-Home-Health-Care.pdf.
If your husband does not qualify for Medicare home health care coverage, here are other options that may apply to you:
See if Programs of All-Inclusive Care for the Elderly is available in your area (seeNPAonline.org). PACE provides in-home care, including help with activities of daily living such as meals, dental and medical care.
To look for these and other programs in your area that can help pay your husband’s home care, go to PayingForSeniorCare.com and click on “Find Financial Assistance for Care” to access their Eldercare Financial Assistance Locator tool.