Does Medicare Cover Home Health Care?

Did you know that more than 27 million Americans were without health insurance in 2022? Access to quality healthcare is a fundamental right for all citizens, especially as we age and require additional support. Many seniors in the U.S. rely on Medicare to help cover various healthcare services, including home health care. 

Home health care services give many older adults valuable independence and the freedom to age in place. But whether Medicare covers the costs associated with it – from hiring home health aides to purchasing home equipment – can vary from one case to another. 

Below, we break down what you need to know about Medicare coverage for home health care services so you or a loved one can seek the support you deserve. 

Key Takeaways

• Medicare is one of the most popular health insurance options for people over 65.
• Home health care services covered by Medicare may include physical therapy, skilled nursing care, and occupational therapy.
• You may be expected to cover some out-of-pocket costs for home health care services, even if Medicare partially covers the total bill. 
• A Medicare-certified home health care agency may be the best resource for those searching for care they can afford.

Who’s Eligible for Medicare Coverage of Home Health Care?

Home health care is an increasingly attractive option for older adults who need help managing activities of daily living (ADLs), boasting cost-effectiveness, enhanced convenience, and comparable efficacy to skilled nursing facility care.

The objective of home health care is multifaceted. Firstly, it strives to facilitate your recovery process, empowering you to regain your independence and bolster self-sufficiency. Additionally, it helps you sustain your existing health status and slow down any potential decline.

Medicare’s home health benefits are valuable for individuals who meet specific criteria. However, to reap these benefits, you must satisfy certain conditions. 

• You must qualify for Medicare. Those eligible include adults 65 or older or individuals living with certain disabilities. 
• You must apply and be approved for Medicare coverage.
• You must be under the care of a doctor or nurse practitioner and receive medical services that are part of a plan that your healthcare provider wrote out for you. 

Your doctor’s prescribed care plan may have several important components to help your health remain stable or improve. Examples include the following:

• Therapy services such as speech or physical therapy
• A home health aid
• Part-time nursing care to help with activities of daily living

You also need to be certified that you are homebound by your healthcare professional. If you have difficulty leaving the home alone or require a wheelchair, crutches, or other special device to help you move, you may be certified as homebound. 

Being homebound does not necessarily mean that you never leave the house. You may occasionally leave for short periods, such as to go to the grocery store or religious services.

The last requirement to be eligible for Medicare-covered home health care is to see your healthcare provider face-to-face. Your appointment must also concern your need for home health care. 

Despite all this, you may not be eligible for coverage from your medical insurance if you need a more frequent plan of care. Medicare only covers intermittent home care, which occurs less than seven days per week.

What’s Covered?

Medicare Part A extends coverage for specific in-home health care services provided they are deemed necessary for treating your medical concerns. Examples may include skilled nursing and therapy services, among others. Medicare will also cover skilled nursing services at home as long as nurses work 28 hours or less weekly.

Home health nurses can take on medical care services that you might not be able to access otherwise from home. They may administer IV drugs, tube feedings, and changing dressings to avoid infection. These services and their costs may also fall under Medicare coverage.

Speech, physical, and occupational therapy are also commonly covered by Medicare, but only if they fit certain requirements. Those who have experienced medical emergencies like strokes or who experience difficulties in these areas due to a disability, illness, etc., can generally receive coverage for these services.

Medicare A & B sometimes covers certain medical social services, but only if the individual first receives skilled nursing care. Certain equipment may also be covered, such as medical devices, bandages, and so on. However, equipment is often charged separately from home health care coverage and may need to meet a Medicare-approved amount.

What Isn’t Covered?

Medicare does not cover 24/7 care. It only goes as far as intermittent skilled nursing care, which is fewer than seven days weekly and less than eight hours daily. If you need care around the clock, your original Medicare plan may not work. 

In most cases, Medicare also does not cover:

• Custodial care, which refers to helping someone get dressed, go to the bathroom, bathing, etc.
• Services to help you with laundry, shopping, or cleaning your home
• Meal delivery

It’s also tricky to receive coverage if your medical needs aren’t considered severe. For instance, if you only need a nurse to come by once a week for a blood screening, Medicare will likely not cover this under home care services. 

Are There Out-Of-Pocket Fees?

While Medicare covers a broad range of services, it doesn’t cover everything. The insurance company must send you an Advance Beneficiary Notice of Noncoverage (ABN) when it does not cover something, and you must pay for it yourself. This may occur if Medicare decides not to cover something it usually covers. 

Likewise, Medicare Part B can cover some medical and home health equipment so long as you can demonstrate a need for it. But you may also need to pay a percentage (usually 20%) of the cost in some cases. This equipment may include the following:

• Oxygen
• Wheelchairs
• Walkers
• Stairlifts
• Homelifts
• Other medical equipment

Finding a Medicare-Certified Home Health Agency

Your primary care physician or referring healthcare provider can provide valuable guidance on home health care needs and may recommend specific Medicare-certified agencies in your area. They can also help determine if you meet the eligibility criteria for Medicare-covered home health services. 

Ensure that your home health agency is Medicare-certified and appropriately licensed in your state. Medicare certification is a baseline requirement, but state licensure ensures compliance with state-specific regulations. Contact the agencies you’re considering and schedule interviews or consultations. 

During these interactions, ask questions about their services, staff qualifications, and experience in providing care for your specific condition. Inquire about their availability, scheduling, and emergency response procedures.

Also, look for patient reviews and testimonials online or request references from the agency. Feedback from previous clients can provide valuable insights into the agency’s quality of care and customer satisfaction. 

Choose an agency with a convenient location that can provide services within your geographical area. Verify their availability to accommodate your scheduling needs. 

Finally, clarify payment options, insurance coverage, and any out-of-pocket expenses associated with the agency’s services. Understanding the financial aspect of home health care is crucial for planning and budgeting.

How to Apply for Medicare-Covered Home Health Care

Applying for Medicare-covered home health care involves collaboration between you, your healthcare provider, and the home health agency. Talk to your healthcare provider and ensure you can choose a home health care agency. 

Your doctor will explain what your Medicare plan might cover and if in-home health care might be the best option for your needs. Listening to your doctor and researching what Medicare covers will help you make the best decision.

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