Does Medicare Cover Home Health Care?

Does Medicare cover home health care? If you need help at home, you’ve probably been considering the alternatives. Let’s find out if you’re eligible for help.

If you sign up for home healthcare services, nurses, physiotherapists, or other trained professionals visit your home to make sure you’re doing okay, taking your medicine, or teaching you exercises to get better. It’s usually more convenient and as effective as the care you get in a hospital.

The cost of home healthcare varies, depending on your location and you may need some help to offset some of the costs. If you’re wondering if Medicare offers help with home healthcare costs, you’ll find answers here.

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Key Takeaways

Medicare covers some home health care services under Part A and Part B, including skilled nursing, therapy, and medical supplies.
Medicare Advantage plans may also cover home health care but specifics can vary.
Costs under Original Medicare include no charge for some services and a 20% coinsurance for medical equipment after meeting the Part B deductible.
Medicare will continue coverage as long as your doctor deems it necessary, with certain limitations on visits and hours.

Does Medicare Cover Home Health Care?

To keep it short, yes. Medicare covers home health care. But let’s go in-depth.

Medicare offers different coverage options:

Medicare Part A covers inpatient care in skilled nursing facilities, hospitals, and some home healthcare services.
Medicare Part B also covers some home health care services, alongside medical services and supplies that are necessary to treat or prevent a medical condition. Another part of Medicare, Part D, covers prescription drugs.

These parts of Medicare work together to provide comprehensive health coverage if you’re eligible. They combine in two major ways, Original Medicare and Medicare Advantage (Part C).

Original Medicare combines Parts A and B, while Medicare Advantage is an alternative to Original Medicare offered by private companies but approved by Medicare.

By now, it’s likely clear that Original Medicare includes home healthcare services in its coverage, given that it includes two Medicare parts (A and B) that encompass such services. Keep in mind that the extent of coverage from Original Medicare is limited; we’ll get to that shortly.

On the other hand, the Medicare Advantage plans offer a range of coverage options that may vary. It’s hard to answer conclusively if that kind of Medicare will cover home health care services, since there are so many different plans available. So, you need to consult the insurance company to know the specifics of the coverage for home health care services.

What Medicare Covers

Remember we mentioned earlier that Medicare offers limited home health care services? Now let’s talk about the services included, and those not covered.

What Services Does Medicare Home Health Care Provide?

Medicare will only cover home health care services if the care you need is crucial for treating your sickness/injury. If a doctor or an approved professional says you need special nursing or therapy services to help you get better or manage your illness, then Medicare can help pay for those services.

With that said, here are some home healthcare services that are included in Medicare:

Physical therapy
Occupational therapy
Speech-language pathology services
Skilled nursing care
Medical supplies like wound dressing
Home health aide services like personal care
Medical social services like counselling
Durable medical equipment
Injectable osteoporosis drugs for women

You can find more details about the home healthcare services Medicare covers here.

What Services Aren’t Included?

The following are outside the scope of Medicare coverage of home health care:

24/7 home care
Shopping, laundry, and similar services
Meal delivery services
Personal care, like bathing, as a standalone service

If you’re not sure if Medicare will help pay for something, you can ask your doctor or home health agency. You can also call Medicare directly at 1-800-MEDICARE (1-800-633-4227).

Additionally, ensure you tell your healthcare provider if you have other health insurance, like Medigap, so they know how to handle your bills correctly.

How Long Will Medicare Pay for Home Health Care?

As long as your doctor says you still need home health care, you’ll remain eligible for Medicare coverage. But there’s a catch. Medicare will only cover a certain number of visits weekly and a limited amount of hours daily.

Also, there’s a 60-day recertification interval. When you start getting health care at home, Medicare covers you for up to 60 days. After that, the doctor or health provider needs to check again to make sure you’re still eligible for continued care. This process keeps going as long as you still need care.

So, after every 60 days, there’s a reassessment to confirm your eligibility for home health care coverage.

Medicare Home Health Care Cost

If you have a Medical Advantage plan, consult your insurance agency for an overview of costs. But for Original Medicare:

You don’t have to pay anything for home health care services like physical therapy.
After you pay the $240 Part B deductible, you have to pay 20% of the cost of medical equipment (like wheelchairs, walkers, and oxygen equipment) that Medicare covers.

If there are things that Medicare won’t pay for, your home health agency should tell you about it and how much it costs. Usually, before care commences, you’ll get a notice called the Advanced Beneficiary Notice of Non-coverage (ABN) that contains information about the services and supplies Medicare won’t pay for.

What Are the Medicare Home Health Care Requirements?

To be eligible for Medicare-covered home health care, you must first meet the eligibility criteria for Medicare. This means that you must be;

At least 65 years
A U.S. resident
A U.S. citizen or an alien who has been granted permission to reside in the U.S. and has lived there for a minimum of five years.

But if you’re younger than 65 years, you can only be eligible for Medicare if you are on Social Security disability benefits.

When you meet either of these terms, there are certain requirements that you must meet to qualify for home health care.

Eligibility Requirements for Home Health Care

Here are the requirements to qualify for Medicare-covered home health care:

A doctor must certify that the home health care is medically necessary
A doctor must confirm that you’re unable to leave your house due to the sickness/injury
Your home health agency must be Medicare-approved
A doctor must establish and periodically review a care plan

To bring these requirements into perspective, let’s consider the real-life example of Sarah, a 70-year-old woman who recently experienced a fall at her home. The fall resulted in a hip fracture that required surgery. Following a five-day hospital stay, Sarah’s doctor determines that while she is not fully healed, she is ready to be discharged.

In her discharge paperwork, Sarah’s doctor specifies that she is homebound and in need of short-term skilled care to aid in her recovery. The doctor outlines the services and equipment Sarah will require for her rehabilitation.

In the example above, we can see that Sarah’s age and situation match the eligibility criteria listed above. Therefore, she is eligible for Medicare-covered home health care to support her recovery process.

Who Isn’t Eligible?

Even when you meet the general Medicare eligibility criteria, it’s possible to not be eligible for Medicare-covered home healthcare services.

You don’t qualify for Medicare coverage of home health care if you need skilled nursing care all the time. Medicare will only cover you;

If you need skilled nursing care for less than 8 hours each day for a maximum of 21 days; OR
Your situation requires skilled care a few times a week (less than 7 days a week).

Finding a Medicare-Certified Home Health Care Provider

If your doctor certifies you need help at home, you can pick a home healthcare agency from a list of Medicare-certified ones in your area. The government sets certain health and safety standards that each agency must meet to become certified. You can find these agencies here.

You get to choose which agency you want to use and everyone else involved in your treatment, including your hospital discharge planner, must respect your decision. But your choice is limited by the number of agencies available in your area. the services they offer, or what your insurance will cover. This applies to Original Medicare.

If you have a Medicare Advantage Plan or another Medicare health plan, they might have their own rules about which home health care agencies you can use. So, call your plan to find out more information.

FAQs about Medicare Coverage for Home Health Care

Health care is confusing, so it’s natural to have questions. If you’re wondering if Medicare will cover home health care, you may also be asking the following:

Does Medicare Cover Home Health Care for Dementia?

Yes, Medicare provides home health care coverage for patients with dementia. However, they must meet the eligibility criteria for Medicare-covered home health care.

Does Medicare Cover Home Health Care for Stroke Patients?

Yes, Medicare-covered home health care is available for stroke patients. However, Medicare will not pay for custodial or long-term care.

Relief Recap

So, does Medicare cover home health care? Yes, Medicare can serve as a lifeline to cover some of the expenses as long as you meet the eligibility criteria. You can get coverage for physical therapy, skilled nursing care, home health aide, and some other medical services relevant to your recovery.

Your doctor has to give the go-ahead and certify that your illness hinders you from moving around and you’d need either of those recovery services. Although there are limitations to Medicare home healthcare coverage, it’s still a valuable option to reduce out-of-pocket costs for treatment.

Faith Boluwatife

Faith is a passionate advocate for social change. She brings a unique blend of professional expertise and personal experience to the discourse on poverty. With a background in humanities and an advanced degree on public health, she has dedicated years to working directly with marginalized communities, both as a volunteer and a seasoned professional.