Does Anthem Cover Home Healthcare?
- Home healthcare services include skilled medical care and home health aide services. Find out if Anthem covers home healthcare services and who is eligible.
Home healthcare services can help you remain living at home if you have a health condition that affects your ability to leave the house or carry out acts of daily living. Some people require skilled medical care at home, and others need help with tasks such as cleaning, meal preparation and personal care.
Although home healthcare services are often essential for maintaining health and well-being, many insurers have strict coverage criteria. This article explains whether Anthem covers home healthcare and who is eligible.
Does Anthem Cover Home Healthcare?
Many Medicare Advantage plans sold by Anthem cover home healthcare services for eligible enrollees. Anthem policies that include home healthcare as a benefit cover up to 124 hours of in-home care per year. You can use this allowance to cover tasks such as respite care, housekeeping assistance and help with acts of daily living. You must choose a licensed care provider to qualify for Anthem home healthcare coverage.
You may also receive additional home healthcare benefits, which could include:
- Up to 64 meal deliveries per year
- Transport to and from medical appointments, up to a maximum of 60 one-way journeys per year
- Up to 24 in-home acupuncture or therapeutic massage treatments
Other types of Anthem healthcare insurance may cover skilled home healthcare services in certain circumstances. Covered services may include nursing care, physical therapy and occupational therapy.
Who Is Eligible for Anthem Home Healthcare Coverage?
Anthem only covers home healthcare services if they're medically necessary. You'll need to meet various eligibility criteria to receive coverage.
First, you must generally be unable to leave your home to qualify for covered home healthcare services. Therefore, enrollees who are bedridden will usually be eligible. However, you may also qualify if you are not bedridden but your condition makes it difficult for you to go out and access the services you need.
If you're sometimes able to leave the house, Anthem may still approve your coverage if you go out infrequently, for short periods or to attend medical appointments. For example, the following scenarios would not necessarily make you ineligible for Anthem home healthcare coverage:
- Attending a licensed adult day care program
- Receiving dialysis or cancer treatment in a medical facility
- Attending a place of worship
- Occasionally attending a special event, such as a funeral, graduation or family reunion
- Infrequent visits to community services, such as a hair salon
Your doctor or another healthcare professional must prescribe covered services in a written care plan. They must update your care plan at least every 30 days to maintain your coverage. Usually, Anthem only covers home healthcare services that are so complex that they require a skilled and licensed professional to perform or supervise them unless you have Medicare Advantage coverage that includes home health aide services.
However, Anthem may cover home healthcare services if your doctor believes they should be given at home, even if you are not housebound. For example, it may approve coverage for the at-home administration of pain medication or certain types of chemotherapy.
When Might Anthem Deny Coverage for Home Healthcare Services?
Anthem may deny coverage for home healthcare services if you are not generally housebound or your doctor cannot justify the medical need for skilled treatment at home. Furthermore, your coverage may end if your treatment achieves the goals stated in your care plan.
Does Medicare Cover Home Healthcare?
Medicare covers home healthcare services in certain circumstances. All Medicare Advantage plans sold by private insurers such as Anthem must cover at least the same services as Original Medicare. Therefore, your Medicare Advantage plan will include any home healthcare benefits you would be eligible for through Medicare Part A or B.
Original Medicare generally covers part-time skilled nursing care and other services such as speech, physical or occupational therapy. It may also cover home health aide services (including homemaker services) if you also require skilled care and you can't claim for unskilled care on its own. Your doctor must recommend any services you need on a written care plan and review it regularly. Medicare excludes certain home healthcare services, including full-time care and meal deliveries.