If you are considering home health or hospice care for you or for a loved one, you may want to find out whether or not you are eligible for your home health or hospice services to be paid for by Medicare. Medicare is a Federal Health Insurance Program for people who are age 65 or older. Medicare also covers people under 65 with certain disabilities or people of any age who have end-stage renal disease. Medicare has two different parts: Medicare Part A – Hospital Insurance and Medicare Part B – Medical Insurance. Hospice and home health care usually fall under Part A.

How Does Medicare Establish Eligibility? The way Medicare determines whether or not a patient is Medicare eligible is finding out if the potential patient or patient’s spouse worked for at least 10 years in Medicare-covered employment. The patient’s eligibility is also determined by whether or not they are 65 years or older and a citizen or permanent resident of the United States. Even if a potential patient isn’t yet 65, they may still qualify for Medicare coverage if they have a disability or permanent kidney failure requiring dialysis or transplant.

Is Hospice Care Covered by Medicare? A patient is eligible for Medicare hospice benefits when:

- The person is eligible for Medicare Part A (Hospital Insurance); and

- The person’s doctor and the hospice medical director certify that the person is terminally ill and probably have less than six months to live; and

- The person signs a statement choosing hospice care instead of routine Medicare covered benefits for the person’s terminal illness*; and (* Medicare will still pay for covered benefits for any health problems that are not related to the person’s terminal illness )

- The person receives care from a Medicare-approved hospice program.

A patient’s doctor and the hospice will work with the patient and family to set up a plan of care that meets their needs.

Here is a list of the hospice services that are covered by Medicare:

- Doctor’s services

- Nursing care

- Medical equipment such as wheelchairs or walkers

- Medical supplies (such as bandages and catheters)

- Drugs for symptom control and pain relief

- Short-term care in the hospital and/or including respite care

- Homemaker services and home health aide services

- Occupational and physical therapy

- Speech therapy

- Social worker services

- Diet and nutrition counseling

- Counseling to help the new patient and their family cope with grief and loss

Medicare pays for nearly all of the costs of these services. Often, the only out of pocket expense that a new patient will have to pay part of the cost on is for outpatient drugs and inpatient respite care.

Does Medicare Cover Home Health Services? Medicare Part A covers specific home health services. Medicare will cover the following home health services for patients:

- Intermittent or part time skilled nursing care by a licensed practical nurse or registered nurse

- Personal care therapy

- Working with an occupational therapist

- Medical supplies that are directly related to your home health care plan, including wound dressings

- Resilient medical equipment

If there is a home health service that Medicare does not cover, instruct your home health care provider inform you as soon as possible so that you can properly plan for your home health expenses. This will help minimize any out of pocket expenditures you have before they are incurred.

Where Can I Find A Medicare Approved Hospice or Home Health Care Provider? You can find a home health or hospice care provider that is Medicare approved by asking your doctor, your State Hospice Organization, or a patient State Health Department. Utah residents can contact Millcreek Home Health and Hospice for answers to their questions about Medicare covered hospice and home health care.

Now that you have a better understanding of what hospice and home health services are covered by Medicare, we hope that you will find a suitable provider and help you or your loved one get the care that they need.

Learn more about Utah Home Health and Hospice Care here.