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Does Medicare cover home health care?


 | Yes, but Medicare Parts A and B require you to meet specific criteria for home health care coverage, particularly if you’re mostly or entirely confined to your home. Medicare will cover part-time or intermittent skilled nursing care, therapy and other aid that’s determined to be medically necessary and ordered by your doctor.

But Medicare won’t pay for care to help you with activities of daily living, such as bathing, dressing, eating or going to the bathroom. If that’s the only care you need, you won’t receive coverage.

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How do I qualify for Medicare home health benefits?

To be eligible for home health benefits, Medicare must approve the home health agency caring for you and you must meet the following criteria:

  • Be homebound. That means you’re unable to leave home without considerable effort or the aid of another person or a device such as a walker or wheelchair.
  • Have certification from a physician or medical professional who works directly with a doctor, such as a nurse practitioner, showing you need intermittent occupational therapy, physical therapy, skilled nursing care and/or speech-language therapy. This certification entails a documented face-to-face encounter with a doctor or medical professional no more than 90 days before or 30 days after the start of your home health care.
  • Be under a plan of care that a doctor establishes and reviews regularly. That plan should note all services needed and how often, the provider, required supplies and the results your doctor anticipates. The doctor and home health team must review and recertify the care plan at least once every 60 days.

What Medicare home health benefits are available?

If you qualify for home health benefits, Medicare may cover the following services:

  • Home health aides to help 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’re also receiving skilled nursing or therapy.
  • Medical social services, such as counseling for social or emotional concerns related to your illness or injury if you’re receiving skilled care. It also covers help in finding community resources, if you need them.
  • Occupational, physical and speech therapy with professional therapists to restore or improve your ability to perform everyday tasks, speak or walk after an illness or injury, or to prevent your condition from getting worse.
  • Skilled nursing care on a part-time or intermittent basis that would require more active care such as changing wound dressings, assisting with feeding and injecting medicine through a feeding tube. Medicare stipulates that care must be provided fewer than seven days each week or daily for less than eight hours each day for up to 21 days.

Medicare may extend that limit if your doctor can predict when your need for daily skilled nursing care will end. Full-time or long-term nursing care typically wouldn’t qualify for home health benefits.

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If you qualify, you pay nothing for home health care services from a home health agency. Other medical services, such as visits to your doctor, are covered under your other Medicare benefits.

You may also have coverage for some supplies, such as catheters and wound dressings related to your condition when your home health agency provides them. This might include durable medical equipment from the home health agency, such as walkers or wheelchairs.

Medicare Part B covers equipment and supplies. But you’ll have to pay the Part B coinsurance, which is 20 percent of the Medicare-approved amount, after you pay your $233 Part B deductible for 2022 ($226 in 2023).

What home health care services won’t Medicare cover?

Additional services that you or a supplemental insurance will have to pay for include:

  • 24-hour at-home care
  • Custodial or personal care for help with daily living activities — if that’s the only care you need
  • Household services, such as shopping, cleaning and laundry when they’re not related to your care plan
  • Meal delivery to your home

How do I find Medicare-covered home health care?

Medicare.gov has a search and comparison tool to help you find certified home health agencies in your area that Medicare covers.

If you have coverage from a private Medicare Advantage plan, rather than original Medicare, you may have to use an agency that works with that Advantage plan. Talk with a Medicare Advantage plan representative about coverage details and requirements.

Before you start receiving care, the agency should let you know, both verbally and in writing, of services provided that Medicare won’t cover and what you can expect to pay for them.

Keep in mind

You may be able to get additional caregiving support through local and state programs, which may provide services such as adult day care programs, equipment, meal delivery, respite care for caregivers and transportation. You can find out more about programs in your area through your Area Agency on Aging. Type your zip code or city and state into the U.S. Administration on Aging’s Eldercare Locator or call 800-677-1116, to find contact information for your local agency and other resources.

Updated October 20, 2022

 

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