Does Medicare Cover Home Health Aides?

Steven Mott by Steven Mott | Licensed since 2012
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This article was updated on: 08/31/2017

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Are you enrolled in the Medicare program? In some cases, Medicare may help you pay for the services of home health aides. Typically this coverage is limited, part-time, and short-term.

Whether you get your Medicare benefits directly through the federal Original Medicare (Part A and Part B) program, or through a Medicare Advantage plan, you might be able to get some of your home health care costs covered.

Original Medicare is made up of two parts, Part A and Part B, and either part might cover home health care, including home health aides, in some situations.

Original Medicare coverage at a glance
Medicare Part A May cover:

  • Inpatient hospital care
  • Care in a skilled nursing facility
  • Limited home health care (possibly including a home health aide) after a hospitalization
  • Hospice care
Medicare Part B May cover:

  • Outpatient services
  • Doctor visits
  • X-rays and lab tests
  • Certain preventive medical services (such as vaccines)
  • Certain home health services (possibly including a home health aide) ordered by your doctor to help you recover from an injury or condition that did not require hospitalization.
Original Medicare coverage limitations at a glance
  • Original Medicare doesn’t cover long-term nursing care at home: you can only receive part-time home health benefits from a Medicare-certified home health agency. If you qualify for this benefit, Medicare typically covers care fewer than 7 days each week or less than 8 hours each day over a maximum period of 21 days. (If you require full-time nursing care, Medicare will not approve home health care coverage.)
  • Medicare won’t cover personal care services such as help with bathing, using the toilet, and dressing if this is the only kind of care you need.

 

How do I know if I qualify for Medicare’s home health care benefit?

You have to meet all of the following conditions for Medicare to cover your home health care (including a home health aide).

  • Your doctor must help set up a care plan in cooperation with the home health agency and regularly review the care you receive.
  • Your doctor must certify that you need one or more of the following part-time services: skilled nursing care, physical therapy, speech language pathology services, and/or occupational therapy.
  • The home health care must be provided by a Medicare-approved agency.
  • Your doctor must certify that you are homebound — in other words, your condition keeps you from leaving home without the help of another person or a supportive device (such as special transportation, a wheelchair, or a walker). Medicare generally considers a person homebound when leaving home takes “considerable and taxing effort.”

When are home health aide and other home care services covered by Medicare’s home health benefit?

If you have Original Medicare, Part A normally pays 100% of the cost of your covered home health services (possibly including a home health aide, as described in the table above) when home care follows a hospital stay of at least three (3) days. Medicare will also pay for an initial evaluation by a home care agency, if prescribed by your doctor, to determine whether you are a good candidate for home care. It may cover a portion of the cost (usually 80%) of medical supplies for use at home and certain medical social services. If your doctor orders home health care and you have not been hospitalized, Medicare may still help you pay for home health care under Medicare Part B (sometimes called medical coverage). You must be enrolled in Medicare Part B and pay the Part B premium to receive this benefit.

Medicare may pay for the following home health-care services when medically necessary for a limited time:

  • Part-time skilled nursing care provided by a registered nurse (RN) or licensed practical nurse (LPN) —usually two to three visits per week in a plan certified by your doctor
  • A home health aide
  • Physical therapy
  • Speech language pathology
  • Occupational therapy

If you’re receiving home health care for one of the above, Medicare may also help you pay for home health aide services when given on a part-time or intermittent basis.  You must need a home health aide as support to skilled nursing care for Medicare to cover this service.

When are home health aides and other home care services not covered by Medicare?

In most cases, Medicare will not pay for certain services sometimes provided as part of home health care, including (but not limited to):

  • Part-time or custodial (long-term) personal care by home health aides such as bathing, dressing, eating, using the bathroom, and other activities of daily living if this is the only care you need
  • Meals delivered to your home
  • Homemaker services such as cleaning, laundry, shopping and preparing meals
  • Full-time nursing care

Medicare requires the home health agency give you a notice called the “Home Health Advance Beneficiary Notice” before giving you services and supplies that Medicare doesn’t cover.

You can learn more about your Medicare coverage from Medicare’s online publications Medicare and Home Health Care and the Medicare handbook entitled Medicare and You – 2017.

Medicare Advantage (Medicare Part C) offers another way to receive your Medicare coverage. Private insurance companies contracted with Medicare provide the benefits of Original Medicare (Part A and Part B) except for hospice care, which remains a service covered only by Medicare Part A. Often Medicare Advantage plans offer additional benefits, such as prescription drug coverage. If you are enrolled in a Medicare Advantage plan, you can get specific information about your plan’s coverage details by reading your benefit booklet (Evidence of Coverage) or contacting your plan.

I invite you to contact me if you would like to learn more about your Medicare coverage and plan options.

  • You can use one of the links below to set up a phone call with me or request personalized information from me by email.
  • You can do some research on your own to get familiar with Medicare plan options in your area by clicking on the “Compare Plans” button on this page.

If you want to talk to us right away, you can call and speak to a licensed insurance agent at 1-844-847-2660 (TTY users can call 711) Monday through Friday, 8AM to 8PM ET.

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