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Does Medicare Pay for Home Health Care?

What is Home Health Care?

A male nurse checks a senior woman's blood pressure at home

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?

A senior man opens the door to welcome a female home health aide

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

Close up of a nurse wearing a mask administering a shot to a senior woman wearing a mask

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

A female home health aide helps a senior woman get into her crutches

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

A female home health aide helps a senior man out of a hospital bed set up in his living room

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

An in-home counselor comforts a distressed senior female client

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)

A senior woman in a wheelchair speaks with her home health aide outdoors

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?

A senior woman wearing a mask is seen having her vitals checked by a home health aide also wearing a mask

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.

At Iora, we want to make sure every patient understands how they can get the most out of their Medicare coverage. If you have any questions about becoming a patient at Iora Primary Care, contact us. You will be connected to one of our patient enrollment coordinators who will be more than happy to help. 

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