Does Medicare Cover Home Health Care? The 2019 Guidelines
Medicare does cover many forms of home health care, including skilled nursing services, skilled therapy services, medical social services, and more. If you or a loved one need home health care, this likely comes as quite a relief. While there are limitations, Medicare has you covered as long as you need only part-time home care.
Let’s take a look at what home health services Medicare covers and how you can qualify for them.
What types of home health care does Medicare cover?
Medicare covers a wide variety of home care, such as the services below:
- Skilled nursing services: Home nursing services covered by Medicare include injections, tube feedings, catheter changes, wound care, care plan management, and medical evaluations. Medicare pays for necessary and reasonable home nursing care in full.
- Skilled therapy services: Physical, speech, and occupational therapy by licensed therapists are included in Medicare’s home health care coverage. Physical therapy helps patients regain movement and ability in various body parts. Speech therapy includes exercises that help people regain or improve speaking ability and is often needed following a stroke or other illness. Occupational therapy is designed to help patients regain the ability to perform activities of daily living such as eating or getting dressed. Note that occupational therapy is covered only if you require other home health care in addition to the occupational therapy. Medicare-covered therapy services are fully insured.
- Medical social services: Counseling and other help to cope with illness are also covered by Medicare as part of home health care. This can include counseling for chronically ill patients or assistance finding community resources. Necessary medical social services are fully covered.
- Medical supplies: Medicare covers medical supplies needed for home health care, including bandages and catheters. Any needed medical supplies are fully covered.
- Durable medical equipment (DME): Medicare will also partially cover durable medical equipment, or DME, for home health needs. DME includes wheelchairs, walkers, bathtub transfer benches, and similar devices. Patients are responsible for a coinsurance rate of 20% for necessary DME.1
What types of home health care aren’t covered?
Not all home health care is covered by Medicare. It will not pay for the following services:
- Occupational therapy: Occupational therapy is not covered if it’s the only service needed. If home health care is medically necessary, though, you can receive occupational therapy as part of the home health care at no cost.
- Homemaker services: These services include help with tasks such as cleaning and shopping, and they are not covered.
- Personal care: Medicare will not cover professional help with tasks such as bathing and dressing if it is the only service necessary. But these services are covered as long as you have medical needs in addition to them.
What are the requirements to receive home health care under Medicare?
Now that you know Medicare covers it, you may be wondering how to qualify for insured home health care. To be eligible for home health care coverage under Medicare, you must be enrolled in Medicare Part A and/or Part B. You must also meet these additional requirements:
- You are considered homebound. For Medicare purposes, you are considered homebound if a doctor certifies that you meet one of the following criteria:
- You need the help of another person or special equipment (like a cane or wheelchair) to leave your home.
- You should not leave home often because of your condition and because it requires significant effort.
- Your doctor has certified that you need skilled nursing care or physical, speech, or occupational therapy.
- You are under the care of a doctor and are receiving health care according to a plan that is regularly reviewed by a doctor.
- You get your care from a Medicare-certified home health agency (HHA).
How long does Medicare pay for home health care?
Medicare covers only intermittent home health care, which means that the care must be for either less than seven days per week or less than eight hours each day over a period of 21 days. Full-time, round-the-clock care is not covered by Medicare.2
Does Medicare cover home health care for patients with dementia?
Medicare coverage for people with Alzheimer’s and other forms of dementia follows the same guidelines as coverage for other patients. Intermittent home health care is covered for a limited period of time, but as the disease progresses, it’s likely that the individual will need more care and supervision than Medicare will cover—remember, Medicare doesn’t cover long-term or full-time home health care.
If your loved one needs more constant care, take a look at our FAQ page about Medicare and assisted living facilities or nursing homes.
How much does home health care cost under Medicare?
Eligible home health care services are covered in full under Medicare as long as the above criteria are met. This includes skilled nursing care, medical supplies, physical and occupational therapy, and more. The only costs the patient is responsible for are the regular Medicare costs they pay, such as Part B monthly premiums.
One exception to this full coverage is durable medical equipment (DME). For DME, patients will be required to pay 20% of the Medicare-approved cost.3 DME includes wheelchairs, walkers, and similar equipment to help with mobility and daily living.
If you need help finding an eligible home health agency, Medicare.gov provides a handy search tool that can help you narrow down your options, and it also offers a checklist of things to look out for when screening potential agencies. And as always, if you have further questions about Medicare-related topics, check out our comprehensive FAQ pages.