Will Medicare Pay for Home Health Care?
If you're recovering from an illness or injury, receiving care at home can be more convenient, cost-effective, and just as beneficial as care in a hospital or skilled nursing facility. But many people ask: Will Medicare pay for home health care? The answer depends on several factors, including the type of care needed and eligibility requirements. In this article, we’ll walk you through what Medicare covers for home health services and how to qualify.
Does Medicare Cover Home Health Care?
Yes, Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) both cover eligible home health care services, but certain conditions must be met. These services are available for individuals who need part-time or intermittent skilled care and are considered “homebound.”
Homebound status means:
You have difficulty leaving home without help (like a cane, walker, or assistance from someone else).
Your condition makes it unadvisable to leave home frequently.
Leaving your home requires a significant effort.
What Home Health Services Does Medicare Cover?
If you meet Medicare’s requirements, you may receive the following covered home health services:
Skilled Nursing Care:
Wound care (e.g., for pressure sores or surgical wounds)
Intravenous (IV) therapy or nutrition therapy
Injections
Monitoring of serious illnesses
Patient and caregiver education
Therapy Services:
Physical therapy
Occupational therapy
Speech-language pathology
Medical Social Services:
Counseling to help with emotional or social factors affecting your recovery
Home Health Aide Care:
Assistance with walking, bathing, or grooming, but only if you’re also receiving skilled care such as nursing or therapy services.
Durable Medical Equipment (DME):
Medicare covers items like wheelchairs, walkers, and hospital beds. You’ll pay 20% of the Medicare-approved amount after meeting your Part B deductible.
Medical Supplies and Devices:
Includes necessary medical supplies and disposable devices for wound therapy.
What Medicare Won’t Cover
Medicare doesn’t cover certain types of care, including:
24-hour home care
Homemaker services, like shopping, cleaning, or meal delivery unrelated to your medical care
Custodial care, such as help with daily activities (bathing or dressing) if that’s the only care you need
Additionally, home health services must be provided part-time or intermittently—Medicare typically covers up to 8 hours per day and no more than 28 hours per week, with some exceptions for short-term needs.
How to Qualify for Medicare-Covered Home Health Care
To receive home health care under Medicare, these steps are required:
Doctor’s Certification: Your doctor or another healthcare provider must have a face-to-face visit with you and certify that you need home health services.
Care Plan: Your doctor must create a detailed care plan outlining the services you need and coordinate with a Medicare-certified home health agency.
Use of a Medicare-Certified Provider: The agency providing your care must be approved by Medicare.
What Are Your Costs for Home Health Services?
For covered home health care, you typically pay:
$0 for home health care services.
20% of the Medicare-approved amount for durable medical equipment (after meeting your Part B deductible).
Before starting care, your home health agency will explain what Medicare will cover and provide an Advance Beneficiary Notice (ABN) if there are services or items that Medicare won’t pay for.
What If I Have a Medicare Advantage Plan?
If you have a Medicare Advantage Plan (Part C), your home health benefits may vary slightly. Contact your plan directly to understand your coverage. If you have a Medicare Supplement Insurance (Medigap) policy or other health insurance, inform your provider to ensure your bills are processed correctly.
Need Help Understanding Medicare Home Health Care?
Home health care can be an excellent option for recovery, but it's essential to understand Medicare’s coverage requirements. With the right plan in place, you can receive high-quality care at home, tailored to your needs. Don’t wait—call us today at 281-466-9985 and let us help you take the next step toward better healthcare!
