Home health care (HHC) offers skilled, intermittent medical services delivered directly in a patient’s place of residence. This care helps individuals recover from an illness or injury, manage a chronic condition, or regain self-sufficiency following hospitalization. Patients often ask whether the home health agency provides the necessary medical equipment and supplies. The answer depends entirely on the type of item needed and the patient’s specific insurance coverage, especially Medicare’s home health benefit.
Defining the Scope of Home Health Supplies
To understand what home health agencies provide, it is necessary to distinguish between two categories of medical items. The first category is consumable medical supplies, which are disposable items used up during a short period and discarded to facilitate skilled medical services.
The second category is Durable Medical Equipment (DME), which is reusable equipment designed for repeated, long-term use in the home. DME must be primarily medical in nature, not generally useful to someone without an illness or injury, and expected to last at least three years. These two categories are covered and provided through different mechanisms.
Consumable supplies include items like gauze, adhesive bandages, sterile dressings for wound care, syringes, and intravenous (IV) tubing. DME encompasses larger, non-disposable items such as hospital beds, wheelchairs, oxygen concentrators, walkers, and patient lifts. These two groups are handled very differently in terms of who provides them and how they are billed under the patient’s medical benefits.
Supplies Covered Under the Home Health Benefit
Home health agencies typically provide consumable medical supplies that are directly required to perform the skilled services outlined in the patient’s plan of care. For example, if a patient is receiving skilled nursing for a complex surgical wound, the agency supplies the specialized wound dressings, sterile gloves, and cleansing solutions needed for each dressing change. This provision is generally included in the overall payment the agency receives for the episode of care, often under the Medicare Home Health Prospective Payment System (PPS).
The cost of these necessary supplies is “bundled” into the episodic rate paid to the home health agency. This means the agency must provide all medically necessary routine and non-routine supplies while the patient is under the active home health plan of care. Examples include materials for intravenous therapy, such as IV start kits and tubing, or supplies for catheter care and changes. The supplies must be directly related to the active skilled intervention the nurse or therapist is performing.
Medicare pays in full for certain supplies, like catheters and wound dressings, when they are provided by a certified home health agency as part of the skilled care. The home health agency that establishes the episode of care is responsible for billing and receiving payment for these specific medical supplies. Once a patient is discharged from the home health episode, the agency is no longer responsible for providing these disposable medical supplies.
Durable Medical Equipment and Separate Vendor Coverage
Unlike consumable supplies, Durable Medical Equipment (DME) is generally not provided or paid for by the home health agency itself. DME is a separate benefit, typically covered under Medicare Part B, distinct from the home health episode of care. Agency staff often help coordinate the process by ensuring the physician writes the necessary prescription or order for the equipment.
The equipment is then furnished by specialized DME vendors or suppliers, not the home health agency. These vendors are responsible for delivering the item, setting it up in the patient’s home, and providing instructions on its safe use. The equipment must meet specific federal criteria, including being able to withstand repeated use and serving a medical purpose.
For covered DME items like a wheelchair, hospital bed, or oxygen equipment, Medicare Part B typically pays 80% of the Medicare-approved amount. The patient is generally responsible for the remaining 20% coinsurance after meeting the Part B deductible. Depending on the item, the patient may have the option to rent the equipment or purchase it outright. DME is billed separately from the home health services.
Patient Responsibility and Non-Covered Items
While the home health benefit covers many costs, patients may still have financial responsibilities for certain items or services. Even with coverage, patients are usually responsible for co-payments and deductibles related to Durable Medical Equipment (DME), which is billed under Medicare Part B. The agency must inform the patient in advance about any costs that Medicare or other insurance will not cover.
Certain items that are helpful for convenience or comfort but are not deemed “medically necessary” are typically the patient’s financial responsibility. Examples of non-covered items include over-the-counter medications, specialized toiletries, or home safety modifications like grab bars and ramps. These items, while improving quality of life, do not meet the strict medical necessity criteria for coverage.
Patients also have responsibilities regarding the maintenance and security of any DME they receive. The patient is typically responsible for properly storing and caring for the equipment while it is in their possession. They may also be liable for the cost of any lost, stolen, or damaged equipment, depending on the terms of the agreement with the DME vendor.