In-Home Health Care under Medicare
This article was updated on: 09/12/2018
Have you just come home from the hospital and need some help at home? In-home health care assistance may be covered for you if you have Medicare.
In 2013, about 4.9 million people received home health care assistance, according to a 2014 study published by the National Center for Health Statistics. So, if you need home health care, you have plenty of company.
What is home health care?
Home health care can involve a wide range of services you may need when you’re ill or recovering from an illness or surgery. In some cases it can include skilled nursing care, physical therapy, or other medical services.
Sometimes home health care can keep you living at home instead of in a nursing home or other facility. But it’s important to understand that Medicare doesn’t generally cover long-term home health care, or every type of in-home care.
In-home care: medical and non-medical
Depending on what is available in your community, home care can include:
- Health care – skilled nursing care; physical, speech, occupational and other rehabilitative therapy; medication administration; monitoring; medical-social services, and medical equipment
- Personal care — assistance with personal hygiene, dressing, getting in and out of a bed or chair, bathing, and exercise
- Nutrition — meal planning and preparation, meal delivery
- Homemaking – housekeeping and shopping
- Social and safety services– escort and transportation services, companions, telephone checks
When it comes to Medicare coverage, home health care may mean skilled care from a nurse, physical therapist, speech therapist, occupational therapist, or social worker. This care must be ordered by your doctor, as explained below.
Does Medicare cover home health care?
Medicare Part A and/or Part B may help pay for your home health care if these conditions apply to you:
- You’re under the care of a doctor who accepts Medicare assignment.
- You’re homebound, which means you need help or special medical equipment such as a wheelchair to leave home. Homebound can mean that your doctor believes leaving your home could be harmful to your health and very difficult. Your doctor must certify that you’re homebound.
- Your doctor orders home health care for you, certifying that you need in-home health care because you’re homebound and need intermittent (not continuous) skilled care. Your health-care provider must create a care plan for you.
- Your health-care provider has to meet face-to-face with you, confirming that you need home health care.
- You receive your care from a Medicare-certified home health agency.
Medicare typically does not cover non-medical, personal home services. For example, if you need help bathing or dressing, but you don’t need skilled medical care, Medicare typically wouldn’t pay for it. However, if you qualify for the home health benefit, Medicare usually covers the following types of care, usually for a limited time:
- In-home, intermittent skilled nursing services. Skilled nursing care includes services that can only be performed safely and effectively by a licensed nurse. Examples of these services might include tube feedings, catheter changes, injections, wound care, and clinical assessments of your condition.
- Home health care assistance, as long as you also need skilled nursing services. If you only require personal care, such as help with bathing, using the toilet, and dressing, Medicare won’t cover these services.
- Physical, speech and/or occupational therapy services that are necessary for treating your illness or injury.
- Medical social services ordered by your doctor to help you with social and emotional concerns you have related to your health condition. This might include counseling or help finding resources in your community.
- Certain medical supplies provided by a Medicare-certified home health agency, such as wound dressings and catheters needed for your care.
- Durable medical equipment, such as a wheelchair or walker.
Medicare typically pays 100% of the Medicare-approved amount for covered skilled nursing and therapy services and 80% of the Medicare-approved amount for covered durable medical equipment.
Note: If you have a Medicare Advantage plan, you get the same benefits provided by Medicare Part A and Part B – they’re just provided through your plan. (Hospice care is the exception – it’s provided by Part A, not through your plan.) A Medicare Advantag plan may require that you use home health agencies that participate in the plan’s network.
Home health care and Medicare Supplement insurance
You might have to pay a coinsurance amount in some cases; for example, under Medicare Part B, you usually pay 20% of durable medical equipment costs (for wheelchairs and certain other equipment and supplies). A Medicare Supplement plan may cover this coinsurance amount and other Medicare Part A and Part B out-of-pocket costs. You can read more about Medicare Supplement (Medigap) insurance.
Not all home health care agencies are created equal
Home health agencies vary in the services they offer, and not every agency is certified by Medicare. You may want to match your needs with the services offered by Medicare-certified home health agencies in your community. Your doctor may suggest a home health agency when ordering your home health care. You can also compare Medicare-certified home health agencies that serve your community by visiting Medicare.gov.
Feel free to contact me if you would like to learn more about home health care and your Medicare coverage.
- 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 also do some research on your own to get familiar with Medicare plan options in your area by clicking on the Compare Plans or Find Plans buttons on this page.
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