American adults that are at least 65 years old are eligible for federal health insurance coverage through Medicare. Coverage includes hospital insurance, medical insurance and prescription drug coverage. But does Medicare cover home health?
Does Medicare cover home health?
Yes, Medicare covers home health services, but only under certain circumstances. The home health agency you choose for your care must be Medicare-certified, meaning they operate under quality standards set by the U.S. government.
You must also have a need for skilled nursing services in order to qualify for home health coverage under Medicare. This can include medical care such as:
- Skilled nursing care (or care that can only be provided by a licensed nurse such as medication education, vital sign monitoring, wound care, infusions, etc.)
- Physical therapy
- Occupational therapy
- Speech-language pathology
- Medical social services
- Home health aide (if receiving other skilled nursing or therapy services)
- Durable medical equipment
- Medical supplies
Learn more about the conditions you must meet to be eligible for home health coverage below.
How do I qualify for home health coverage under Medicare?
In order to be eligible for home health coverage under Medicare, you must:
- Have Part A and/or Part B Medicare
- Have a physician-certified need of skilled nursing care (other than drawing blood)
- Have a physician-certified need of physical therapy, speech-language pathology or occupational therapy
- Additionally, your condition must be expected to improve in a reasonable and predictable period of time
- You need a skilled therapist to make a maintenance program or help you complete maintenance therapy for your condition
- You must be homebound and a physician must certify that you’re homebound
- According to the Center for Medicare & Medicaid Services (CMS), being homebound means you have trouble leaving your home without an assistive device (like using a cane, wheelchair, walker, or crutches) or help from another person
Example: Would Paul qualify for home health coverage?
Paul had arm surgery. He is still able to move around his home with ease, but leaving the house on his own is very hard because he can’t operate a car by himself. His physician recommends physical therapy and certifies that Paul is homebound until he recovers from his surgery. Since Paul is certified as homebound by his physician, needs physical therapy on his arm and has Medicare insurance, he would qualify for home health coverage under Medicare.
If you are caring for an aging parent or family member, you may be unsure how to find the best solution that meets their health care goals and needs. There are signs that may indicate your loved one could benefit from home health care as an option.
What home health services are not covered under Medicare?
To have Medicare cover the price of home health services, you must have a skilled nursing need. That being said, Medicare does not pay for any type of personal care that helps with activities of daily living unless you have a skilled nursing need.
Other services Medicare does not cover the cost of include:
- 24 hour supervised care in your home
- Meal delivery
- Home care or home services such as shopping, cleaning and laundry
If you need these types of services and you don’t have a skilled nursing need, you may be better suited for home care.
Example: Would Carmen qualify for home health coverage?
Carmen is in her late 80s and has started having trouble dressing herself and using the bathroom on her own. She has no other medical issues. Since Carmen only needs help with activities of daily living and not skilled nursing, she would not qualify for home health coverage under Medicare.
How much does home health cost with Medicare coverage?
If your home health care need is completely covered by Medicare and you meet all of the qualifying conditions, Medicare will pay for 100% of your home health care services.
Whenever you begin your care with a home health agency, they should go over costs and if any additional services are not covered by Medicare. Ask for this information to be explained to you and given to you in writing. They should provide an Advance Beneficiary Notice before giving you any supplies that are not covered under Medicare.
It’s important to note that each person’s situation is different. The following circumstances may interfere with full Medicare coverage:
- You may need services more often than Medicare covers
- You may need services that Medicare doesn’t cover
- The specific amount you owe may depend on other factors such as
- Other insurance you have
- How much your doctor charges
- If your doctor accepts assignment
- The type of facility you are receiving care from
- Where you go for a test, item or service
Please always consult your physician or health care provider and ask questions to understand the need for certain services and if Medicare will pay for them.
What is the difference between Medicare Part A and Medicare Part B?
Medicare Part A is the hospital insurance component of Medicare. This offers coverage for inpatient care, or care where you must stay overnight to receive treatment in a medical facility. This includes hospitals, skilled nursing or from the home with home health or hospice care.
Medicare Part B is the medical coverage component of Medicare. This helps cover services such as preventative or routine visits from physicians or health care providers. It can also help cover outpatient care or home health care, and the cost of medical equipment such as wheelchairs, walkers or hospital beds needed during your care.
You can qualify for home health coverage under either Medicare Part A or Part B depending on your specific circumstances. When finding a home health care agency to work with, make sure to verify your Medicare coverage with them.
How do I find Medicare-certified home health care?
Medicare makes it easy to find certified home health care. You can visit Medicare.gov to search for a qualified home health provider near you.
Enhabit Home Health & Hospice is the fourth-largest Medicare-certified home health and hospice provider in the nation. Visit our website to find a location near you and talk to your physician about a referral to our services.
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At Enhabit our patients are our number one priority. From providing the latest medical practices to building deep personal connections, we’re focused on upholding every patient’s dignity, humanity and sense of control on their health care journey.
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