What Does Medicare Cover for Home Health Care? 

According to government statistics, seniors are living longer and relying more and more on home health care services. Home health care is quickly gaining popularity among seniors because it’s more cost effective and it lowers their chances of getting life-threatening infections while under care in a hospital or skilled nursing facility.  

Getting health care at home also promotes aging in place and living a more independent, high-quality life. And these days, most seniors want to remain in their homes for as long as they can. 

Home health care providers like skilled nurses, trained therapists, and social workers provide services to treat a patient’s illness or injury while they’re at home. The Medicare program ensures that this type of care is just as good as what you would get as an inpatient in a hospital or nursing facility but at a lower cost and more convenience. 

If you, or a person you are caring for, would benefit from health care at home, you can learn more about how Medicare offers coverage for these services in this article. 

What does Medicare cover for home health care? 

Home health care benefits under Medicare Part A (inpatient hospital insurance) and/or Part B (outpatient medical insurance) can include services such as:

• Skilled nursing care on a part-time or intermittent basis. 
• Physical and/or occupational therapy
• Speech-language pathology
• Medical social services
• Home health aide care on a part-time or intermittent basis if you are getting skilled nursing or therapy services at the same time. 
• Durable medical equipment and supplies for home use
• Injectable osteoporosis drugs for women

Medicare doesn’t cover around-the-clock care, delivered meals, homemaking services unrelated to your care, and custodial care (bathing, dressing, etc.). 

How can you get home health care benefits under Medicare? 

1. You must be eligible for the home health care benefit by meeting all the following criteria:

• You are enrolled in Medicare.
• You are being cared for by a Medicare-affiliated physician who creates a care plan and reviews it regularly. 
• Your physician must certify that you need intermittent skilled nursing care, physical therapy, speech-language pathology, or occupational therapy for a reasonable amount of time. 
• Your physician certifies that you are homebound. 

2. After your physician certifies you for home health care, a home health agency makes an appointment to visit you at home. You discuss your health condition and the needs you have.

3. Home health agents discuss your care plan with your physician. They keep your health care providers informed during your care.

4. Staff from the home health agency visit you at home according to orders from your health care provider. 

How much does Medicare pay for home health care services? 

Original Medicare Part A pays 100 percent of the cost for covered home health care services. 

If you require durable medical equipment during home health care, Medicare Part B pays for 80 percent of the approved final amount of equipment or supplies that are rented or purchased from medical suppliers that accept Medicare assignment. You are responsible for paying the remaining 20 percent of the cost after you have met your annual Part B deductible. 

The home health care agency providing care for you should inform you, before beginning care, as to how much your Medicare benefits pay. They should also inform you of items or services they may provide that aren’t included in your Medicare benefits. This should be done formally by providing an Advance Beneficiary Notice.