How Does Medicare Cover Home Nursing? My husband has a chronic health condition that makes it very difficult for him to leave the house, so I wonder if he could qualify for Medicare Home Nursing.

Searching for help

Dear seekers,

Medicare covers a variety of part-time or intermittent home health services for needy beneficiaries if they meet Medicare’s criteria. This is how it works.

In order for your husband to have home health insurance coverage, Medicare first requires him to be home chained. This means that it must be extremely difficult for him to leave the house and he will need either the help of another person or a medical device such as a walking stick, wheelchair, walker or crutches.

He must then have a face-to-face interview with his doctor to obtain a home nursing certificate confirming that he needs qualified care or therapy on a part-time basis from a physiotherapist or speech therapist.

His doctor may also call for the services of an occupational therapist and personal care assistant to help with daily living activities such as bathing, dressing, and using the toilet. His family doctor has to renew and certify his health plan every 60 days.

He must also hire a Medicare certified home health agency.

If he meets all the requirements, Medicare should pay for his home care.

Be aware, however, that Medicare will not pay for personal care services (bathing, getting dressed, using the toilet, etc.) on its own unless it also requires qualified care or therapy services. Housewife services such as shopping, food preparation and cleaning are also not covered.

If your husband has original Medicare, you can find a Medicare-certified home health agency at 800-633-4227 or at Medicare.gov/care-compare. If he has a Medicare Advantage plan, you should contact his plan directly and ask which home health authorities are working with the plan and are within the plan’s provider network.

For more detailed information on how Medicare covers home health care, see the Medicare and Home Health Care online brochure at Medicare.gov/Pubs/pdf/10969-Medicare-and-Home-Health-Care.pdf.

Other options

If your husband does not qualify for Medicare home health insurance, there are other insurance options depending on your situation. Here are a few that might apply to you:

Insurance: If you have long-term care insurance, check to see if it covers home care. Or if you have life insurance, see if it can be used to pay for care.

Medicaid: If your income is low, your husband may be eligible for Medicaid, which offers a variety of home and community-based services that can be used to pay for home care. To investigate, contact your local Medicaid office.

Also see if PACE – which stands for “All Inclusive Care Programs for the Elderly” – is available in your area (see NPAonline.org). PACE provides home care, including assistance with daily living activities such as meals, dental and medical care, among other things.

Veteran Perks: If your husband is a veteran, the VA also has some perks that can help you out. Two programs to inquire about are Aid and Attendance or Housebound Allowances and the Veteran-Directed Care program. Both programs offer monthly financial benefits to eligible veterans that can help pay for home care. To find out more, contact your regional VA benefits office (see Benefits.va.gov/benefits/offices.asp or call 800–827–1000).

To find these and other programs in your area that can help pay for your husband’s home care, go to PayingForSeniorCare.com and click “Find Financial Assistance for Care” to search for the financial tool Access Eldercare Assistance.

Submit your senior questions to: Savvy Senior, PO Box 5443, Norman, OK 73070, or visit SavvySenior.org. Jim Miller is a contributor on the NBC Today Show and author of The Savvy Senior.