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Will Medicare Pay for Home Health Care for Dementia Patients?
Date Updated: December 20, 2024
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Ashlee Shefer is a freelance copywriter, content writer, and digital marketer who specializes in senior care, mental health, health care, and other wellness-related topics. She has one year of experience writing both short- and long-form content related to senior resources, assisted living, nursing homes, and home care, including blog posts, research-based articles, resource guides, product reviews, facility blurbs, finances, and care costs.
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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 pays for home health care for dementia patients who meet certain eligibility requirements and request services from a Medicare-approved agency. However, not all Medicare plans cover home health care, and some restrictions apply. Coverage also depends on what services a person needs and how often they require care.
Eligibility Requirements for Medicare-Covered Home Health Care
Medicare Part A or Part B covers part-time or intermittent home health care for homebound patients with dementia. This requirement means an individual struggles to leave the house without a companion or using assistive devices, such as a walker, cane or wheelchair. It also includes seniors who experience significant hardship when leaving home or whose doctor advises them not to leave the house.
Additionally, a doctor or other medical provider must meet the individual in person and deem home health care medically necessary for the patient's health and well-being. After this step, the doctor provides a list of local Medicare-approved agencies and develops a care plan.
What Home Health Care Services Does Medicare Cover for Dementia Patients?
If a doctor has advised a person with dementia not to leave home, and the patient needs part-time or intermittent home health care, they may qualify for Medicare coverage. Medicare covers a range of at-home services for dementia patients, including:
- Medically necessary skilled nursing care, such as health monitoring, nutrition therapy or medication administration
- Physical, occupational or speech therapy
- Medical social services
- At-home medical supplies
- Durable medical equipment
Additionally, Medicare covers assistance with personal care tasks, such as bathing, grooming and mobility, but only if an individual simultaneously receives skilled nursing or rehabilitative care. However, it won't cover personal care assistance if it's the only support a person needs. Other services that Medicare does not cover include 24-hour at-home care, home meal delivery and help with daily living tasks unrelated to a person's care plan, such as shopping or housekeeping. Home care better serves dementia patients who need personal care support but not skilled nursing care.