Does Medicare Cover Home Health Care?
Medicare home health care services are benefits that provide skilled nursing care, therapy and other assistance to people who are mostly confined to their homes. Original Medicare pays the cost of home health care services if you meet certain eligibility requirements.
Medicare Coverage of Home Health Care
Home health care aims to provide treatment for an illness or injury within the comfort and privacy of your home.
If you qualify, Medicare covers a range of services if they’re reasonable and necessary for your treatment.
About 12,000 home care agencies provided care to 3.4 million Medicare beneficiaries in 2017, according to Kaiser Health News.
- Home Health Aides
- These professionals can assist with tasks of daily living, such as bathing, dressing or going to the bathroom. These services are only covered if you also currently receive skilled nursing or therapy.
- Skilled Nursing Care
- A registered nurse or a licensed practical nurse can provide skilled nursing care. Services may include giving IV drugs, administering certain injections, tube feedings and changing bandages.
- Occupational, Physical and Speech Therapy
- Professional therapists can provide services to help you improve your ability to perform everyday tasks such as speaking or walking.
- Medical Social Services
- Services can include counseling or help finding resources in your community for emotional support. Medicare does not cover these services unless you already receive skilled care.
- Medical Supplies
- This can include items such as catheters and wound dressings provided by your home health agency. Medicare may also cover some of the cost for durable medical equipment, such as a wheelchair or walker.
Who Is Eligible?
Medicare beneficiaries must meet certain eligibility requirements in order to qualify for home health care.
- Be under the care of a doctor.
- Receive services under a plan of care created by a doctor.
- Be homebound.
- Have a doctor certify that you need intermittent occupational therapy, physical therapy, skilled nursing care or speech language therapy.
- Receive care from a Medicare-certified home health care agency.
Home Health Care Not Covered Under Medicare
While Medicare pays for many aspects of home health, not all services are covered.
- 24-hour home care
- Meals delivered to your home
- Homemaker services, such as grocery shopping or housework
- Personal care — such as bathing, dressing and eating — when this is the only care you need
Medicare Costs for Home Health Care
If you’re eligible, Original Medicare (Part A and Part B) will pay all costs for home health care services ordered by a doctor and provided by a certified home health agency.
Medicare pays the full cost of home health care for up to 60 days at a time. Medicare can continue to cover costs as long as your doctor recertifies every 60 days that the home services are still medically necessary.
You will be responsible for a 20 percent copayment for the Medicare-approved amount for durable medical equipment.
Before your care begins, the home health agency should disclose how much Medicare will pay. The agency should also inform you when items or services are not covered by Medicare, and how much you’ll owe.
If you meet the criteria for Medicare home health care, you may not have any coinsurance or copayments.
Since Medicare Supplement plans, also known as Medigap, typically pay coinsurance or copayments, your Medicare Supplement plan may not be necessary to cover the costs of home health care.
However, a Medigap plan can help cover the 20 percent copay for durable medical equipment.
If you have a Medigap policy or other health coverage, tell your doctor or health care provider so your services are billed correctly.
All Medicare Advantage plans (Part C) must provide at least the same level of home health care coverage as Original Medicare. However, plans may impose different rules, restrictions and costs.
For example, while Original Medicare fully covers home health costs for those who qualify, some Medicare Advantage plans may require you to pay a copayment for your care.
4 Cited Research Articles
- Graham, J. (2020, February 3). Why Home Health Care Is Suddenly Harder To Come By For Medicare Patients. Retrieved from https://khn.org/news/why-home-health-care-is-suddenly-harder-to-come-by-for-medicare-patients/
- AARP. (n.d.). Does Medicare Cover Home Health Care? Retrieved from https://www.aarp.org/health/medicare-qa-tool/does-medicare-cover-home-healthcare/
- Centers for Medicare & Medicaid Services. (n.d.). Medicare and Home Health Services. Retrieved from https://www.medicare.gov/sites/default/files/2018-07/10969-medicare-and-home-health-care.pdf
- Medicare.gov. (n.d.). Home health services. Retrieved from https://www.medicare.gov/coverage/home-health-services