Medicare Home Health Care: Navigating Coverage for Home Services

Handling a senior’s healthcare needs at home can be complex—but Medicare’s home health benefit is designed to cover skilled nursing and therapy services without requiring a move to a facility. In this guide, we’ll walk you through eligibility rules, covered services, costs, and how to find a Medicare‑certified agency. Plus, learn how Maxona Care takes the guesswork out of benefits so you can focus on care.

1. What Is Medicare Home Health Care?

Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) jointly cover home health care when all of the following conditions are met:

• You’re under the care of a physician, with a plan of care certified by that doctor.

• You need one or more skilled services—such as nursing care, physical therapy, or speech therapy.

• Your home is your primary residence, and you are homebound, meaning leaving home requires considerable effort and assistance.

When these criteria are satisfied, Medicare will pay for intermittent (part‑time) skilled services in the home, often at no cost to you.

2. Eligibility Criteria

To qualify for Medicare home health care:

1. Physician’s Orders: A doctor must certify the need for skilled services and review the plan regularly.

2. Homebound Status: You can leave home infrequently and only with great difficulty—e.g., for medical appointments.

3. Intermittent Care Needs: Medicare covers up to 35 hours per week of skilled nursing or therapy, or 7 days of full‑time skilled care.

4. Medicare‑Certified Agency: Services must be provided by an agency approved by Medicare.

3. Services Covered

Under Medicare home health care, you have access to:

• Skilled Nursing Care: Wound care, medication administration, IV therapy.

• Therapies: Physical, occupational, and speech therapy to maintain or improve function.

• Medical Social Services: Counseling and support for emotional or social challenges.

• Home Health Aide Services: Personal care—bathing, dressing—when provided along with skilled care.

• Durable Medical Equipment (DME): Wheelchairs, hospital beds, walkers, and related supplies.

Medicare may also cover certain medical supplies and a limited number of telehealth visits related to home health.

4. Costs & Out‑of‑Pocket

Most Medicare home health care comes with:

• $0 Premium: No additional premium beyond your Part B monthly premium.

• No Deductible: Medicare waives the Part A deductible for home health services.

• 20% Coinsurance for DME: You pay 20% of the Medicare‑approved amount for durable medical equipment.

There is no copay for skilled nursing or therapy visits when ordered by your physician and delivered by a Medicare‑certified agency.

5. Finding a Medicare‑Certified Agency

When you Google “home health agencies near me” or “home health aide services near me,” look for:

1. Medicare Certification: Verify on Medicare.gov’s “Home Health Compare” that the agency is certified and has high quality ratings.

2. Service Area: Ensure the agency serves Cedar Falls–Waterloo and can rapidly begin care—often within 24–48 hours of doctor’s orders.

3. Range of Services: Confirm they provide all the skilled services you need—nursing, multiple therapy disciplines, and home health aides.

4. Care Coordination: Ask whether they offer a single point of contact to manage scheduling, benefit verification, and ongoing plan updates.

6. How Maxona Care Simplifies the Process

At Maxona Care, we streamline every step:

• Benefit Verification: We confirm your Medicare eligibility and communicate directly with your physician to secure timely orders.

• Certified, Local Clinicians: Our licensed nurses and therapists deliver skilled visits—and our home health aides provide personal care exactly when you need it.

• Care Coordination: A dedicated coordinator handles scheduling, documentation, and any prior‑authorization requirements.

• Transparent Communication: You receive clear visit summaries, progress notes, and reminders—so you always know what services were provided and what’s coming next.

7. Getting Started

1. Ask Your Doctor: Request a referral for Medicare‑covered home health care.

2. Contact Maxona Care: Call (470) 756‑1751 or visit www.maxonacare.com to schedule a free consultation and benefit check.

3. In‑Home Assessment: Our clinician visits to confirm homebound status, review medical needs, and develop your personalized plan of care.

4. Begin Services: With orders in hand, we launch skilled nursing, therapy, and aide visits—often within 1–2 business days.

Navigating Medicare home health care doesn’t have to be overwhelming. With the right agency partnership, you gain expert clinical oversight, personal comfort, and clear guidance on coverage. At Maxona Care, we’re committed to delivering quality home health care near me—so you and your loved one can focus on healing and well‑being.

Reach out today at (470) 756‑1751 or stop by Cedar Falls, IA 50613. Let us simplify your Medicare benefits and bring skilled home care services directly to your door.