Does Anthem Cover Home Healthcare?

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, not all private insurance plans cover home health services beyond what Medicare already covers.

Learn more about Anthem Medicare Advantage (Medicare Part C) plans, how they may or may not cover home healthcare and who is eligible.

Does Medicare Cover Home Healthcare?

Medicare Part B 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 (Medicare Parts A and B).

This means a 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.

Original Medicare doesn't cover certain home healthcare services like full-time custodial care and meal deliveries. 

Does Anthem Cover Home Healthcare?

Some Medicare Advantage plans sold by Anthem or one of its affiliate companies may help cover some home healthcare services Original Medicare doesn't cover. 

Medicare Advantage plans from Anthem can also cover things like a Medicare flex card with a prepaid allowance plan members can use to buy qualified over-the-counter (OTC) health products or other approved products and services.

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.

Plans that offer these benefits may not be available in all areas, however, and some benefits may be subject to a deductible and/or coinsurance costs.

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. 

Helpadvisor.com is owned and operated by Tranzact, the parent company of TZ Insurance Solutions LLC, which is the owner/operator of Medicareadvantage.com and other websites mentioned on HelpAdvisor and which has a financial relationship with some of the carriers listed on HelpAdvisor.