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Does Medicare Cover Home Health Care?

En español | 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.

In 2017, Medicare spent $17.7 million on home health services for 3.4 million beneficiaries, more than double the amount expended in 2001, according to the federal Medicare Payment Advisory Commission.

To be covered, the services must be ordered by a doctor, and one of the more than 11,000 home health agencies nationwide that Medicare has certified must provide the care. Under these circumstances, Medicare can pay the full cost of home health care for up to 60 days at a time. 

That period is renewable, meaning Medicare will continue to provide coverage if your doctor recertifies at least once every 60 days that the home services remain medically necessary.

Qualifying for home health coverage

To be eligible for Medicare home health benefits, you must meet all of these conditions: 

  • You are homebound. 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.

Range of home health benefits

Either element of original MedicarePart A hospital insurance and/or Part B doctor visits and outpatient treatment — might cover home care. Services include these:

  • 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.

Medicare does not cover: 

  • 24-hour care at home
  • Custodial or personal care when this is the only home care you need.
  • Household services such as shopping, cleaning and laundry when they are not related to your care plan.
  • Meal delivery to your home

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.

If you have a Medicare Advantage plan from a private insurance company, you may have to use an agency that the plan works with. 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.

Editor's note: This article was originally published on Jan. 1, 2014. It has been updated with the latest information regarding Medicare coverage in 2020.


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