Does Medicare Pay for Home Health Care?
December 10, 2020 | Medicare & Insurance Education
What is Home Health Care?
Home health care is a wide range of health care services that can be given in your home for an illness or injury, according to Medicare.gov. Home health care can be less expensive and just as effective as care you would receive in a hospital or nursing facility. Plus, it is convenient and done in the privacy of your home. Home health care consists of services ranging from wound care to the monitoring of serious illnesses. Ultimately, the goal is to help you get better and receive the quality care you deserve while living independently.
Which Home Health Care Services are Covered by Medicare?
You may be wondering, “Does Medicare pay for home health care?” Yes, Original Medicare Part A (hospital insurance) and Part B (medical insurance) cover eligible home health care services, including:
- Skilled nursing services
- Skilled therapy services
- Medicare Home Health Aide Coverage
- Medical Social Services
- Medical Supplies
- Durable Medical Equipment (DME)
According to Medicare.gov, home healthcare services not covered by Medicare include:
- 24-hour-a-day care at home
- Meals delivered to your home
- Homemaker services such as shopping, cleaning and laundry
- Custodial or personal care like bathing, dressing or using the bathroom
Skilled Nursing Services
Skilled nursing services consist of wound care, injections, physical therapy, monitoring of vital signs and more. These services are provided by skilled and licensed medical professionals. Services cannot exceed eight hours a day or 28 hours a week. However, Medicare will cover up to 35 hours per week on a case-by-case basis. Usually, these kinds of services are necessary for short term rehabilitation due to an illness or injury. In addition, for patients who require frequent care due to a chronic medical condition.
Skilled Therapy Services
Speech, physical and occupational therapy are examples of skilled therapy services. An individual may need these services if they have an illness or injury. Physical therapy services include training exercises to help regain movement and strength. Speech/language services include vocal exercises to help individuals regain their speech and communication skills. Lastly, occupational therapy allows individuals to regain, improve or maintain the skills needed for everyday activities. These activities include walking, eating, bathing and more.
Medicare Home Health Aide Coverage
Home health aides are skilled in nursing and/or therapy services. Services include personal care such as help with bathing, dressing and using the bathroom. Training requirements for home health aides vary by state. However, under federal law, home health aides must have a minimum of 75 hours of training through a program approved by their state. If you receive skilled nursing or therapy services, Medicare will cover a home health aide.
Medical Social Services
Medical social services are paid for in full by Medicare. Although, the service needs to be ordered by a doctor to help with social and emotional concerns related to an illness. Services include counseling and connecting individuals to community resources if need be, and they are performed by licensed counselors and social workers.
Medical Supplies Covered by Medicare
According to Medicare Interactive, Medicare will pay in full for certain medical supplies such as catheters and wound dressings. However, that is if the supplies are provided by a Medicare-certified home health agency (HHA).
Durable Medical Equipment (DME)
Generally, individuals will pay 20 percent of the Medicare-approved amount for durable medical equipment after they pay their Part B deductible for the year, according to Medicare.gov. Medicare pays the other 80 percent of the Medicare-approved amount. DME that Medicare covers includes, but is not limited to:
- Blood sugar monitors
- Canes, crutches, walkers, wheelchairs, and scooters
- Commode chairs
- Continuous passive motion devices
- Hospital beds
- Infusion pumps & supplies
- Lancet devices & lancets
- Nebulizers & nebulizer medications
- Oxygen equipment & accessories
- Patient lifts
- Pressure-reducing support surfaces
- Suction pumps
- Traction equipment
Do I Qualify for Medicare Home Health Coverage?
You may be wondering if you or a loved one qualifies for home health coverage. If you have Medicare Part A and/or Part B insurance, home health care will be covered. However, you must meet the following requirements:
- You must be homebound. This means it is nearly impossible to leave your home.
- You need skilled nursing services such on an intermittent basis. This means at least once every 60 days and at most once a day for up to three weeks.
- Meet with a doctor face-to-face. This could be an office visit, hospital visit or even a virtual visit. In addition, the visit must be within 90 days of beginning your home care or 30 days after receiving care.
- A signed home health certification from a doctor. The form must confirm the individual is homebound, has an approved plan of care, and has met face-to-face with the doctor.
- Lastly, care must be from a Medicare-certified home health agency (HHA).
If you or a loved one needs additional help answering questions like, “Does Medicare pay for home health care?” call 1-800-MEDICARE.