What Does Medicare Home Health Care Cover?

What home health services does Medicare cover?

Medicare home health care is care you receive at home for an illness or injury. It is meant to help you recover, maintain your current condition or level of function, or slow a decline when skilled care is medically necessary.

Covered home health services may include:

• Part-time or intermittent skilled nursing care, such as wound care, injections, or monitoring of a serious health condition when skilled nursing is required.
• Physical therapy to help improve or maintain movement, strength, balance, or function.
• Speech-language pathology services for certain speech, swallowing, or communication problems.
• Continued occupational therapy when it remains medically necessary after other qualifying skilled services begin.
• Medical social services, such as counseling or help connecting with community resources related to your care plan.
• Part-time or intermittent home health aide services, such as help with bathing or dressing, when you also need covered skilled care.
• Certain medical supplies used as part of your home health care.

Who qualifies for Medicare home health care?

Medicare coverage depends on meeting several requirements. In general, a doctor or other allowed provider must determine that you need home health care and must create or approve a plan of care.

You generally must:

• Be under the care of a doctor or allowed provider.
• Need intermittent skilled nursing care, physical therapy, speech-language pathology services, or continued occupational therapy.
• Be considered homebound under Medicare rules.
• Receive care from a Medicare-certified home health agency.
• Have a face-to-face visit related to the need for home health care within the required Medicare time frame.

Homebound does not mean you can never leave home. It generally means leaving home requires a considerable effort, assistance, or special equipment. Short or infrequent absences, including for medical care or certain occasional nonmedical events, may not automatically prevent coverage.

How often can Medicare home health staff visit?

If you qualify, Medicare says you can receive covered home health visits as ordered in your plan of care. The number and type of visits depend on your medical needs and your provider’s orders.

For skilled nursing care and home health aide services, Medicare generally defines part-time or intermittent care as up to 8 hours a day combined, for a maximum of 28 hours per week. In some cases, Medicare may cover more frequent care for a short time if your provider decides it is necessary.

Medicare home health is not designed to replace full-time caregiving or round-the-clock supervision.

What does Medicare not cover as home health care?

Medicare home health benefits have important limits. Medicare generally does not cover:

• 24-hour-a-day care at home.
• Meals delivered to your home.
• Homemaker services, such as shopping, cleaning, or laundry, when they are not part of your covered care plan.
• Personal care, such as help bathing, dressing, or using the bathroom, when this is the only care you need.

If a home health agency believes Medicare will not pay for an item or service, it should tell you before providing it and explain what you may have to pay.

What does Medicare home health care cost?

For covered home health services under Original Medicare, you generally pay nothing. If you need Medicare-covered durable medical equipment, such as certain wheelchairs, walkers, or hospital beds, you usually pay 20% of the Medicare-approved amount after meeting the Part B deductible.

Costs may be different if you are enrolled in a Medicare Advantage Plan. Medicare Advantage plans must cover Medicare-covered home health benefits, but they may have network rules, prior authorization requirements, or different cost-sharing. Check your plan before care begins when possible.

How do you start Medicare home health care?

Home health care usually starts with your doctor or allowed provider evaluating your condition and deciding whether you need skilled care at home. If you qualify, the provider works with a Medicare-certified home health agency to create a plan of care.

The home health agency should explain what services Medicare is expected to cover, how often staff will visit, and whether any items or services may not be covered. You can use Medicare’s Care Compare tool to find and compare Medicare-approved home health agencies in your area.

Official Sources