Does Medicare Cover Home Health Care?

The following article answers the question "Does Medicare cover home health care?" and provides the steps to get home care for a loved one. The video (left) also outlines the steps to getting home care.

Does Medicare Cover Home Health Care?

Yes, according to AARP, Original Medicare can cover the full cost of medically necessary home health care on a limited basis for beneficiaries who are unable to leave home without assistance. That could include:

- Skilled nursing care

- Occupational, physical and speech therapy

- Home health aide services, if the recipient also needs therapy or skilled nursing

Original Medicare can also cover routine home care (for the difference between Home Health Care and Home Care, click here) daily activities such as help with bathing and dressing as well as basic medical care such as checking vital signs and dressing wounds—only on a part-time or intermittent basis, and only if a doctor orders it as part of a broader plan of care.

 

Note: Original Medicare will not pay for full-time home care or for personal and home services if that is the only help needed.

However, Medicare Advantage plans (which are private insurance policies that match Original Medicare's coverage but can provide additional benefit) have the option to offer broader and longer-term coverage for home health services. For example, an MA plan might cover a personal care aide even if the recipient does not need therapy or skilled nursing. Check with the plan provider to understand what is available for each particular plan.

In order to qualify for home health care, a patient must meet the following criteria:

  • Must be considered "home-bound," based on the Centers for Medicare & Medicaid (CMS) criteria.

  • Must require skilled care on a part-time or intermittent basis to improve, maintain, prevent or further slow your loved one's health condition.

  • Must be under the care of a doctor

  • Must receive home health care from a Medicare-approved home health care agency

How do I check if a Medicare plan covers home health care?

Check with your plan provider by calling your state's number (find it here) or visit their coverage list search tool: https://www.medicare.gov/coverage.

How do I get started?

  1. Start by searching the federal government's Eldercare Locator to find your local Area Agency on Aging. These agencies have resources on home health care and are the gateway to Medicaid, if needed.

  2. You can also check the National Council on Aging's BenefitsCheckUp to learn which additional programs you or your loved one may qualify.

  3. Help with home-care bills may be available through Medicaid if the care recipient has a low income or limited assets. Speak with your Medicare representative to find out which home health services and under which circumstances, are covered.

  4. If applicable, contact the Department of Veterans Affairs (VA) to see if your loved one qualifies for home-care support as a former service member.

  5. Contact your local PACE organization.

  6. Lastly (or maybe firstly), speak with your tax accountant regarding tax deductions available. Then, when you are fully informed, speak with your loved one's doctor to form a plan of action.

What is the process of getting home health care?

The video above also outlines the following steps to getting home health care:

  1. See medical provider. It all starts with the doctor, who will evaluate your loved one's needs.

  2. Get a plan. After evaluation, the doctor will create a Home Health Care (HHC) plan.

  3. Contact Medicare. Check with your plan provider by calling your state's number (find it here) or visit their coverage list search tool: https://www.medicare.gov/coverage.

  4. Find accredited, Medicare-approved home health care providers. Use our directory (red button) to find accredited providers and this link to find Medicare-approved providers.

  5. Interview and assess potential providers. Use our questions to assess and select.

  6. Re-assess. Be prepared to re-assess on a regular basis.

For more information, please see our Frequently Asked Questions page.

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Published February 4, 2020

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