Aging Options

Many Are Missing Out on Home Health Coverage Through Medicare

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If you’re a Medicare-eligible senior who needs home health care, you may be surprised to learn that Medicare may cover the costs. But many qualified seniors never apply, while others find their benefits cut off prematurely, all because Medicare home health benefits are widely misunderstood.

That’s the conclusion in this recent article on the financial website, which describes the challenge some seniors find in taking advantage of this important benefit. For seniors recovering at home after a hospital stay, or those who can’t easily leave home, home health care is a critical – and expensive – need. Medicare benefits can make all the difference, according to Kiplinger.

As the article explains, “Medicare covers in-home services, including skilled nursing and physical therapy.” It goes on to say that “for eligible patients, there’s generally no charge and no limit on how long they can receive the benefit.” That’s the good news. The problem, patient advocates say, is that both patients and providers fail to understand the rules for eligibility. “Confusion over the rules means that some patients never seek care because they mistakenly believe they won’t qualify – while others are wrongfully denied care or see their services terminated prematurely,” says Kiplinger.

There are quite a few seniors who do take advantage of the home health care benefit through Medicare – about 3.5 million in 2014, according to the Centers for Medicare and Medicaid Services. Covered services include part-time skilled nursing, physical or occupational therapy, or speech-language pathology, any of which must be provided by a Medicare-certified home health agency. The care plan has to be established and approved by the senior’s personal physician. (The Kiplinger article contains a link to a Medicare website that lists approved home health service providers.)

One of the biggest areas of misunderstanding, says the Kiplinger piece, comes with the definition of “homebound.” Many patients and even some providers assume “homebound” means bed-ridden, but that’s not true. Quoting the Kiplinger article: “To be homebound under Medicare’s rules, your illness or injury must cause you to have trouble leaving your home without help.” This kind of help could include using a walker, for example, or needing special transportation. That means you may be able to leave your house from time to time (with assistance) and still meet the Medicare requirements. (According to Kiplinger, just to make things more confusing, some Medicare Advantage plans waive the homebound requirement altogether.)

Finally, what happens if you feel your Medicare-provided home health benefits are denied, or terminated prematurely? We encourage you to read the Kiplinger article because it includes some important links and instructions that can help you appeal the decision. Free help is also available through most State Health Insurance Assistance Programs. There have been class action lawsuits brought by patients who felt Medicare was treating them unfairly. In other words, if you feel you’re entitled to benefits, don’t give up.

Here at Aging Options we would be pleased to help you navigate some of these complex retirement-related questions. This is what we have been successfully doing for many years, helping clients from all walks of life plan for a secure and fruitful retirement. Your need for medical coverage, such as that provided by Medicare, is just one aspect of what we call a LifePlan. We also help you make sure you’ve planned for your housing choices, made the right legal decisions, established a sound financial plan and kept your family fully informed of your hopes and desires. A LifePlan becomes your blueprint as you build the retirement future you’ve always dreamed about.

You can start the process quickly and easily by attending a free LifePlanning Seminar at a location near you. For dates, times and simple on-line registration, visit our Upcoming Events page. There’s no obligation whatsoever – and we guarantee you’ll come away armed with helpful information. We welcome the opportunity to answer your questions and to work with you on your LifePlan.

(originally reported at


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