If you’re eligible for Medicare and need home health care, Part A and Part B will cover your home health care services if you qualify.
Whether you have Part A and Part B coverage through Original Medicare or a Medicare Advantage plan, home health care services are needs-based and may have limits to what is covered.
If your health needs change or you need home health care for the first time, it’s a good idea to verify that the services you need are covered by Medicare.
Yes, Medicare home health care benefits are available for those with Original Medicare (Parts A and B) and Medicare Advantage (Part C). Services are needs-based, and there are limits to what is covered.
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Yes. Whether you have Original Medicare (Parts A and B) or Medicare Advantage (Part C) through a private insurance company, you can expect Medicare to pay for some home health care benefits if you need them.
Here are some basic eligibility guidelines:
- You must have a care plan that is reviewed regularly by your doctor.
- You must be certified by your doctor as being homebound.
- Your doctor must certify you need part-time or intermittent skilled nursing care, physical therapy, speech-language pathology or occupational therapy.
Treatments are usually approved if:
- Your condition will improve.
- You need services to maintain your current condition.
- You need a skilled therapist to help safely perform maintenance therapy.
How Much Does Medicare Pay for Home Health Care?
Parts A and B will cover 100% of Medicare in-home care services if you qualify. That’s true of both Original Medicare and Medicare Advantage. Some Medicare Advantage plans may require a copayment, depending on the plan. Medicare home health care also covers 80% of Medicare-approved costs for durable medical equipment. You’ll need to pay the Part B deductible first.
How much does medicare pay for home health care per hour?
Medicare often pays providers different amounts for different services. It’s always a good idea to check with your home health agency to ensure the care you’re getting is approved and covered by Medicare. For a list of Medicare-approved agencies in your area, you can check the Medicare Home Health Compare [i] tool or call GoHealth. Our licensed insurance agents won’t just show you the agencies in your area. They’ll make sure your plan provides the coverage you need.
Coverage can be complicated, so make sure you know the basics about Medicare home health care:
- If you have Original Medicare, Parts A and B cover any qualified home health care you receive.
- Because it must provide at least the same level of care as Original Medicare, Medicare Advantage (Part C) also covers qualified home health care services.
- Medicare Advantage also may cover home health care services that Original Medicare doesn’t.
What Home Health Care is Covered by Medicare?
Medicare services covered by Medicare can range from skilled nursing care to occupational therapy. Here are some of the available Medicare home health care benefits available to you if you qualify:
- Skilled nursing care that’s intermittent or part-time
- Care from a home health aide that’s intermittent or part-time
- Physical therapy
- Speech-language pathology services
- Occupational therapy
- Medical social services
- Women: Injectable osteoporosis drug
It’s also important to understand what’s not covered. Medicare home health care services typically don’t provide 24-hour, full-service care. On the other hand, Medicare Advantage may provide some services that Parts A and B don’t. These can include:
- Home meal delivery
- Custodial and personal care including bathing, dressing and using the restroom, if this is the only care needed
- Homemaker services
- Full-time, live-in care
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Medicare will pay for home health care for the duration of time your doctor says you need the care. It’s common to wonder, does Medicare cover home health care, and for how long? Generally, your care is required to be on a part-time or intermittent basis. Medicare defines this requirement as:
- Fewer than 8 hours a day.
- Fewer than 28 hours per week.
Medicare may approve more care when it’s recommended and planned for by your doctor. [i]
- Medicare recertifies your eligibility for these benefits every 60 days.
- Your eligibility is assessed every 30 days if you receive therapy.
- If your provider deems your treatment effective, you can receive another 30 days [i]
There are a couple of options outside of home health care that you may consider, including:
Skilled Nursing Facility
Part A may cover care in a certified skilled nursing facility. It must be medically necessary for you to have skilled nursing care, e.g., changing sterile dressings.
Your Medicare plan may cover respite care for a caregiver. This allows for a member to stay up to five days in a Medicare-approved facility, including a nursing home.
Medicare does not cover room and board at nursing homes for long-term care. If you qualify for Medicare and Medicaid, your state’s Medicare program may offer some benefits for assisted living.
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