In-Home Health Care under Medicare
Last Updated : 06/20/20194 min read
You may be wondering if Medicare will pay for in-home health care if:
- You’re home from the hospital or a skilled nursing facility.
- You need assistance with daily tasks at home, but you haven’t recently been hospitalized.
- You need nursing care at home.
- You want to stay in your home as long as possible before moving to an assisted living or other care facility.
Medicare might cover some in-home health care in some situations – but not all. Let’s get into the details.
When might Medicare cover in-home health care?
In general, Medicare doesn’t cover long-term home health care. Here’s how Medicare coverage of in-home health care typically works.
In most cases, even when Medicare covers in-home health care, it’s for part-time care, and for a limited time. Some of the requirements may include:
- You must be under the care of a doctor, who must have a plan of care for you that she or he regularly reviews.
- The in-home health agency must be Medicare-approved.
- Your doctor must certify that you’re unable to leave your home without some difficulty – for example, you might need transportation and/or help from a cane, a walker, a wheelchair, and/or someone to help you. In other words, you’re homebound.
- Your doctor has to certify that you need certain kinds of in-home care, such as:
- Skilled nursing services (besides just drawing blood) when you don’t need constant care. That is, you need these services intermittently.
- Continued occupational therapy*
- Physical therapy*
- Speech language pathology*
This may not be a complete list.
*Medicare has certain rules about covering this type of service. If your doctor orders it for you, you may want to contact your Medicare Advantage plan, or Medicare, to see if it’ll be covered. Contact information for Medicare is at the bottom of this page.
What types of in-home health care does Medicare cover?
If your situation meets Medicare criteria, Medicare may cover in-home health care such as:
- Skilled nursing care (part-time or intermittent)
- Part-time home health aides (intermittent)
- Medical social services
- Physical or occupational therapy
- Speech language pathology
Medicare benefits might also cover:
- Durable medical equipment
- Medical supplies
- Injectable osteoporosis drugs
If you qualify for home health care under Medicare, you generally don’t have to pay any coinsurance or copayment. If you need durable medical equipment, you’ll typically pay 20% of the Medicare-approved amount as coinsurance. Read more about Medicare and durable medical equipment.
When does Medicare not cover in-home health care?
In most cases, Medicare doesn’t cover these types of in-home health care.
- Home health aides, when the only care you need is custodial. That means you need help bathing, dressing, and/or using the bathroom.
- In-home meals (delivered to your home)
- Round-the-clock care (24 hours a day)
- Homemaker services, like cleaning, laundry, and shopping. If these services aren’t in your care plan, and they’re the only care you need, they’re generally not covered.
It’s important to know that just because your doctor might recommend home health care, Medicare doesn’t automatically cover it. It depends on your situation.
Do Medicare Advantage plans cover in-home health care?
Medicare Advantage plans provide your Medicare Part A and Part B coverage. Instead of getting Part A and Part B through the federal government directly, you get them through a private insurance company that contracts with Medicare.
So, your in-home health care benefits will be at least the same as what Medicare Part A and Part B offer (except for hospice care, which comes directly from Part A). Medicare Advantage plans may have annual deductibles, and may charge coinsurance or copayments for these services. Medicare Advantage plans have out-of-pocket maximum amounts, which protect you from unlimited health-care spending.
You’ll need to keep paying your Medicare Part B premium (along with any premium the plan may charge) when you have a Medicare Advantage plan.
Want to learn more about Medicare Advantage plans? It’s easy to take a look at the plans in your area and see what benefits they offer besides Medicare Part A and Part B coverage. Just type your zip code in the box on this page, and you can compare Medicare Advantage plans at your convenience.