In-Home Health Care under Medicare
This article was updated on: 06/11/2019
If you need Medicare home health care after a hospitalization or due to a condition that keeps you homebound, Medicare might cover a home health aide. Here’s the information you need to know about Medicare coverage of home health services.
A Medicare Advantage plan might cover some home health services.
What home health aide services are covered by Medicare?
Original Medicare (Part A and Part B) generally only covers home health aide services such as skilled nursing care, occupational or physical therapy, or speech-language pathology services. If you only need home health aide services for help with bathing, dressing, and other activities of daily living (also known as custodial care), Original Medicare typically doesn’t cover those services.
For example, let’s say your doctor arranges for home nursing and physical therapy visits to help you recover from a stroke. Medicare may cover part-time, intermittent home health aide services if your doctor believes they are medically necessary for your treatment plan.
How do I qualify for Medicare home health care?
Medicare has several requirements to cover home health aide services and other home health care:
- Your doctor must write a formal treatment plan specifying the home health services you need and certifying that you need the services to improve or maintain your condition. This is usually done in consultation with the home health agency that will be treating you.
- You must be certified by your doctor as homebound, which means you are unable to leave home without assistance or special transportation. Medicare may consider you homebound if leaving the house requires “considerable and taxing effort.”
- Your doctor must monitor the services you receive at home.
- Your home health agency must be approved by Medicare.
If you meet all of the above requirements, Medicare may cover part-time, intermittent home health aide services for up to 21 days. Medicare generally covers fewer than seven days a week of home health aide visits, and fewer than eight hours of care per visit.
If you need full-time, daily home health care, Medicare Part A and Part B might not cover it. The Medicare home health care benefit is only for intermittent, part-time services for less than 21 days. A Medicare Advantage plan might cover some home health care as described later in this article.
What do I have to pay for Medicare home health care?
If your claim is approved, Medicare Part A generally pays 100% of allowable home health agency charges. This may include an initial consultation visit by the home health agency if your doctor requests one. The home health care must follow a qualifying hospital stay of at least three days before your Medicare benefits apply.
If you haven’t had a hospital stay, Medicare Part B might still cover home health care visits. Your doctor would need to recommend these visits as part of a formal, written treatment plan. Part B generally covers 80% of allowable charges for durable medical equipment and devices you need for your treatment at home. Your Part B deductible applies.
Does Medicare Advantage cover home health aide services?
Medicare Advantage plans are offered by private insurance companies. They must provide the same coverage as Original Medicare at a minimum. Some many plans offer additional benefits to their members, including expanded coverage for home health care.
Some Medicare Advantage plans may include limited home health benefits. This coverage might include coverage for at-home meal and grocery delivery, transportation to and from doctor visits, and home health aide services for custodial care not typically covered under Original Medicare.
Not all Medicare Advantage plans offer these benefits, and those that do may have limitations on how the benefits can be used. For example, the plan may choose to cover up to 50 hours per year of home health aide services, or 20 transportation trips per year. They may also require you to use a network home health agency or transportation provider. You may have a copayment or coinsurance amount for these services.
Different Medicare Advantage plans can have different extra benefits. It’s important to consult your plan benefit booklet to see what Medicare home health care services are covered and the cost-sharing structure for these services.
To look for a Medicare Advantage plan that covers home health aides, enter your zip code on this page.