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Does Medicare Cover In-Home Care After Knee Replacement?
Date Updated: December 9, 2024
Written by:
Lauren Thomas is a seasoned writer that specializes in long-term care, with a special focus on dementia-related topics. She holds a degree in counseling and uses her knowledge and experience to create insightful content that gives seniors and families the information they need to make important care decisions.
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Dr. Brindusa Vanta is a health care professional, researcher, and an experienced medical writer (2000+ articles published online and several medical ebooks). She received her MD degree from “Iuliu Hatieganu” University of Medicine, Romania, and her HD diploma from OCHM – Toronto, Canada.
Medicare may cover home health care services after a knee replacement if a doctor deems services medically necessary and a home health care provider administers them. Additionally, these services must directly relate to recovery. Medicare benefits do not cover nonmedical in-home care alone. Qualified beneficiaries may also receive skilled services such as rehabilitative therapy following knee replacement surgery.
What Is In-Home Care versus Home Health Care?What Is In-Home Care versus Home Health Care?
In-home care includes nonmedical services that help you remain independent and safe at home. This type of care doesn’t require medical training and includes:
- Help with bathing, dressing or personal grooming
- Companionship
- Transportation for errands and appointments
- Meal planning and preparation
- Medication reminders
- Light chore assistance
Home health care, on the other hand, encompasses skilled nursing services from health care professionals such as nurses, aides, rehabilitation therapists and certified nursing assistants. It includes services that require medical training, such as:
- Wound care
- Pain management
- Disease monitoring and management
- Rehabilitative therapies
- Nutritional guidance
What Services at Home Does Medicare Cover After a Knee Replacement?
Medicare pays for part-time or intermittent in-home care services if you need this type of care to maintain your health or recover from surgery. In order to obtain coverage for personal care services, you must receive them from your home health care provider and receive them alongside skilled care, such as physical therapy, and skilled nursing services. If nonmedical in-home care is the only type of care you need, Medicare doesn't provide coverage.
To be eligible for home health care as a Medicare beneficiary, you must be housebound and under the care of a Medicare-certified doctor. Additionally, your doctor must certify your need for services at home, and a Medicare-certified home health agency must provide the services. Following a knee replacement surgery, these services include:
- Intermittent or short-term skilled nursing services
- Occupational or physical therapies
- Medical social services
- Pain management
- Medical supplies
How Can I Pay for In-Home Care?
If nonmedical in-home care is the only type of support you need, many alternatives to Medicare help you pay for services if your current income falls short. For example, depending on your assets, a reverse mortgage or annuity can increase your monthly cash flow and help you pay for custodial care. Alternatively, other health insurance plans, such as Medicaid waivers and long-term care insurance, reduce or eliminate out-of-pocket care costs. You can also arrange a collective sibling agreement or cash in a life insurance policy to receive a lump sum of cash.