Understanding Medicare and Medicaid for Home Health Care

In-home medical care is a vital option for many individuals who need specialized care without leaving home. However, one of the biggest challenges is understanding how Medicare and Medicaid work and how they can help cover these services.

If you or a loved one need home health care, this article will explain:
✅ What services Medicare and Medicaid cover
✅ Who qualifies for these benefits
✅ The steps to apply for in-home medical care

What Services Does Medicare Cover for Home Health Care?

Medicare is a federal health insurance program for individuals 65 and older and certain people with disabilities. Medicare Part A and Part B may cover specific home health care services, but only if the patient meets certain requirements.

🔹 Services Covered by Medicare:
✔ Skilled Nursing Care – Medical care provided by licensed nurses for disease management, medication administration, and wound care.
✔ Physical, Occupational, and Speech Therapy – Helps improve mobility, independence, and communication.
✔ Medical Social Work Services – Counseling and coordination of community resources for the patient’s well-being.
✔ Durable Medical Equipment (DME) – Includes wheelchairs, hospital beds, and oxygen equipment when medically necessary.

Important: Medicare does NOT cover daily living assistance services such as help with bathing, meal preparation, or housekeeping if these are the only services required.

What Does Medicaid Cover for Home Health Care?

Medicaid is a government-funded health insurance program for low-income individuals. In Florida, Medicaid can cover home health care through the Long-Term Care Waiver Program, designed for seniors and individuals with disabilities who require long-term assistance.

🔹 Services Covered by Medicaid:
✔ Personal care and daily assistance – Help with bathing, dressing, meal preparation, and mobility.
✔ Home health aide services – Supervision and companionship to improve the patient’s quality of life.
✔ Therapies and rehabilitation – In-home physical, occupational, and speech therapy.
✔ Palliative and hospice care – Support for individuals with terminal illnesses.

If the patient qualifies for Medicaid, these services may be fully covered.

Who Qualifies for Home Health Care Under Medicare?

For Medicare to cover home health care, the patient must meet the following requirements:
✅ Be considered “homebound” – The patient must have difficulty leaving their home without the help of another person or a device such as a walker or wheelchair.
✅ Require intermittent medical care – Services must be time-limited and medically necessary.
✅ Be under a physician’s care – A doctor must supervise the patient’s treatment plan.
✅ Receive services from a Medicare-certified agency – Agencies like Advance Abilities Health meet the requirements to provide these services.

Medicare requires a doctor’s certification stating that the individual needs home health care before coverage is approved.

Steps to Obtain Home Health Care Through Medicare or Medicaid

If you or a loved one need home care and want to understand how to access these benefits, follow these key steps:

 1. Consult with a Doctor
✔ The first step is to have the patient’s doctor assess their health condition and determine whether they qualify for home health care.
✔ If the patient meets the requirements, the doctor will issue a medical order for the necessary services (nursing, therapy, etc.).

 2. Verify Medicare or Medicaid Coverage
✔ If the patient has Medicare, check whether services are covered under Part A or Part B.
✔ If the patient has Medicaid, determine eligibility for the Long-Term Care Waiver Program or other assistance programs.
✔ At Advance Abilities Health, we can assist with coverage verification and the enrollment process.

3. Contact a Medicare and Medicaid-Certified Home Health Agency
✔ Once the medical order is approved, you must choose a certified home health agency to provide the services.
✔ Advance Abilities Health is fully certified and meets all requirements to offer high-quality home care.

4. Schedule an In-Home Assessment
✔ A nurse or specialist will evaluate the patient’s condition at home to create a personalized care plan.
✔ The assessment will determine which services the patient needs and the frequency of visits.

5. Start Home Health Care Services
✔ Once Medicare or Medicaid approves the services, the patient will begin receiving care at home.
✔ The medical team will continuously monitor progress to ensure the treatment is effective and safe.

At Advance Abilities Health, we guide families through every step of the process to ensure they receive the best possible care.

Why Is It Important to Receive Home Health Care from a Professional Team?

✅ Greater Comfort and Safety – Receiving care at home reduces the risk of hospital infections and improves the patient’s emotional well-being.
✅ Personalized Care – Healthcare professionals design a custom treatment plan for each patient.
✅ Continuous Medical Supervision – Allows for ongoing monitoring of the patient’s progress and adjustments to their treatment plan.
✅ Reduced Unnecessary Hospitalizations – With an in-home care team, health complications that could lead to hospitalization can be prevented.

At Advance Abilities Health, our team of highly trained nurses, therapists, and home health aides is ready to help you understand your options and ensure the best in-home care.
If you have questions about Medicare or Medicaid coverage for home health care, contact us today for a free consultation.