Does Medicare Cover Home Health Services?

Medicare Benefits Solutions
Jul 22, 2020

Medicare categorizes many healthcare services under the heading of home health care. If you are ill or injured, but not sick enough to be an inpatient in a hospital or skilled nursing facility, you can get certain healthcare services at home if you qualify for Medicare. 

Here’s a look at what these home health care services include, how Medicare covers them, and how you can qualify for the benefits.

What is home health care?

Getting professional healthcare at home for an illness or injury is more convenient, less expensive, and more comfortable for the patient and family. The care at home can be just as good as what you’d receive in an inpatient setting. 

The goal of home healthcare is to help you get better, to regain independence and self-sufficiency, or to slow any decline due to your condition. 

Professional home healthcare agencies send qualified caregivers to your home to care for your needs and it is their responsibility to do the following:

• Make sure that you’re eating and drinking, and to ensure it is healthy and sufficient

• Regularly check and record your blood pressure, temperature, heart rate, and breathing

• Make sure that you’re taking your prescriptions and other drugs or treatments correctly

• Evaluate your pain level

• Ensure that you are safe in your home

• Teach you how you can take care of yourself

• Coordinate your care with you, your doctor, and any other medical providers involved

Are you eligible for the home healthcare benefit?

You are eligible for home healthcare if you have Original Medicare Part A and/or Part B, or have a Medicare Advantage (Part C) plan, and all of the following conditions are true for you:

  • You are under the care of a physician and getting services through a plan of care created and reviewed regularly by a health care provider.
  • A physician must certify that you need one or more of the following services:
    • Intermittent skilled nursing care (other than just drawing blood)
    • Physical therapy, speech-language pathology, or continued occupational therapy services if they are specific, safe and an effective treatment for your condition. The therapy you get must be such that you could not get it from anyone other than a qualified therapist. Also, the amount, frequency and time period of therapy needs to be reasonable. To be eligible for therapy, your condition must be expected to improve, or you need it for an effective maintenance program, or you need it for safety reasons. 
  • Your health care provider must certify that you are homebound. 

If you are eligible for home healthcare services, Medicare pays 100 percent of all approved costs for the allowed services. For durable medical equipment (DME) that you rent or purchase for use at home to maintain or recover health, Medicare pays 80 percent and you pay the remaining 20 percent of the approved cost. You must purchase or rent the DME from a supplier that accepts Medicare assignment. 

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What services does the Medicare Part A home healthcare benefit include?

  • Skilled nursing services for up to seven days per week or a total of 28 hours per week. In some cases, Medicare may extend your coverage to 35 hours per week. 
  • A licensed or certified nurse, or another person under their supervision can do the following:
  • • Injections
    • Tube feedings
    • Catheter changes
    • Observe and assess your condition
    • Manage and evaluate your care plan
    • Take care of wounds
  • Skilled therapy services including physical, occupation, and/or speech therapy that may be necessary to treat your condition. 
  • Home health aide services for custodial care like bathing, dressing, and using the toilet. These services are included in the benefit coverage only if you need skilled nursing care too.
  • Medical social services include any services your doctor orders involving social and emotional concerns that you have because of your illness.
  • Medical supplies like wound dressings and catheters only if they come from a Medicare-certified home health agency.

How Does Medicare Part B contribute to your at-home care?

Medicare Part B pays for 80 percent of the cost of renting or purchasing durable medical equipment you may need to use at home for your illness or injury if you get the approved equipment from a Medicare-approved supplier.

Getting home healthcare services with Medicare Advantage

Many Medicare recipients choose to enroll in a Medicare Advantage (MA) plan. Part C Medicare Advantage plans are required to cover at least the same benefits as Original Medicare, but most MA include additional coverage at little to no extra cost. If you are require home healthcare, you should contact your MA plan directly to find out if they provide additional benefits above and beyond the standard Part A and Part B coverage.

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