Home Health Services
Does Medicare Cover Home Health Care?
Home health care services are a valuable Medicare benefit that provides skilled nursing care, therapy and other aid to people who are largely or entirely confined to their homes.
To be covered, the services must be ordered by a doctor, and a home health agency that Medicare has certified must provide the care.
Medicare (Part A and/or Part B) typically covers the following home health services:
- Part-time or “intermittent” skilled nursing care such as changing wound dressings, feeding through a tube and injecting medicine, provided on a part-time or intermittent basis. Your combined home nursing and personal care cannot exceed eight hours a day or 28 hours a week, except in limited circumstances. If you need full-time or long-term nursing care, you probably will not qualify for home health benefits.
- Home health aides to assist with personal activities such as bathing, dressing or going to the bathroom if such help is necessary because of your illness or injury. Medicare covers these services only if you also are getting skilled nursing or therapy.
- Occupational, physical and speech therapy with professional therapists to restore or improve your ability to perform everyday tasks, speak or walk in the aftermath of an illness or injury or to help keep your condition from getting worse.
- Medical social services such as counseling for social or emotional concerns related to your illness or injury if you’re receiving skilled care and help finding community resources if you need them.
- Medical supplies such as catheters and wound dressings related to your condition when your home health agency provides them. This might also include durable medical equipment from the home health agency, such as walkers or wheelchairs, but for those Medicare does not pay the full cost. You usually are responsible for 20 percent of the Medicare-approved amount.
- Osteoporosis drugs for women that are injected – Medicare helps pay for an injectable drug for osteoporosis and visits by a home health nurse to inject the drug if you meet these conditions
Generally, your home health care agency coordinates the services the doctor orders for you.
Medicare does not pay for:
- 24-hour-a-day care at home
- Meals delivered to your home
- Homemaker services (like shopping, cleaning, and laundry), when this is the only care you need
- Custodial or personal care (like bathing, dressing, or using the bathroom), when this is the only care you need
Note: If you have a Medicare Advantage plan, your plan may cover some services not covered by original Medicare. Check with your insurance agent to ask what home healthcare benefits may be covered by your plan.
Who is eligible?
To be eligible for Medicare home health benefits, you must meet all of these conditions:
- You are home bound. That means you are unable to leave home without considerable effort or without the aid of another person or a device such as a wheelchair or a walker.
- You have been certified by a doctor, or by a medical professional who works directly with a doctor (such as a nurse practitioner), as being in need of intermittent occupational therapy, physical therapy, skilled nursing care and/or speech-language therapy.
- That certification arises from a documented, face-to-face encounter with the medical professional no more than 90 days before or 30 days after the start of home health care.
- You are under a plan of care that a doctor established and reviews regularly. The plan should include what services you need and how often, who will provide them, what supplies are required and what results the doctor expects.
- Medicare has approved the home health agency caring for you.
You’re not eligible for the home health benefit if you need more than part-time or “intermittent” skilled nursing care. You may leave home for medical treatment or short, infrequent absences for non-medical reasons, like attending religious services. You can still get home health care if you attend adult day care.
Your costs with Original Medicare
- $0 for home health care services.
- 20% of the Medicare-approved amount for durable medical equipment (DME) .
Before you start getting your home health care, the home health agency should tell you how much Medicare will pay. The agency should also tell you if any items or services they give you aren’t covered by Medicare, and how much you’ll have to pay for them.
This should be explained by both talking with you and in writing. The home health agency should give you a notice called the Advance Beneficiary Notice before giving you services and supplies that Medicare doesn’t cover.
Medicare’s website has a search and comparison tool to help you find certified home health agencies in your area. If you have original Medicare, Parts A and B, you can choose any approved agency.
Medicare Advantage (Part C)
If you have a Medicare Advantage plan from a private insurance company, you may have to use an agency that is in the plan’s network.
Before you start receiving care, the agency should let you know, verbally and in writing, whether some of the services they provide are not covered by Medicare and what you would pay for them.