Does Medicare Cover Home Health Care?

• by Christian Worstell
• July 25, 2023
• Reviewed by John Krahnert

Original Medicare (Medicare Part A and Part B) does cover some limited home health services.

Medicare Advantage (Part C) plans also cover the home health care benefits offered by Original Medicare, and they may also cover additional benefits not covered by Part A and Part B.

What home health care does Medicare cover?

Some of the eligible home health services that Medicare Part A or Part B may cover include:

• Part-time skilled nursing care
• Part-time home health aide care
• Medical social services
• Physical and occupational therapy
• Speech-language pathology services

Home health services are typically covered only if they are considered medically necessary by your doctor. A home health care agency can help you coordinate your home health services.

What home health care does Medicare NOT cover?

Original Medicare does not typically cover:

• 24-hour-a-day care at home
• Homemaker services
• Meal delivery
• Custodial or personal care such as help with dressing or bathing, if that is the only care you need

Who is eligible for Medicare home health care?

Generally, anyone enrolled in Medicare Part A and/or Part B who meets the following conditions can have their home health care covered by Medicare:

• A doctor certifies that you are homebound
• You are under the care of a doctor
• A doctor certifies that you require one or more of the following:
• Part-time skilled nursing care
• Physical therapy, speech-language pathology, or occupational therapy services

Home health services are only covered by Medicare when they are specific, safe and an effective treatment for your health condition.

How much does home health care cost with Medicare?

Even if your home health care services are covered by Medicare, you may have to pay some money out of pocket.

Typically, you’ll pay $0 for Medicare-covered home health care services and 20% of the Medicare approved amount for durable medical equipment (DME).

Ask your home health agency how much Medicare will pay before you begin receiving home health care. This can help prevent you from being surprised by unexpected out-of-pocket costs.

Medicare may cover some services provided in an assisted living facility

Although the housing cost charged by an assisted living facility will not be covered by Medicare, residents of assisted living homes can still benefit from Medicare coverage for certain services.

Assisted living facilities typically have nurses on staff or nurses who visit throughout the day to treat injuries, illness and help manage medications. Any such medical (non-custodial) care received in an assisted living facility by a health care provider may be covered by Medicare in the same fashion that it would be covered at other facilities.

Doe Medicare Advantage plans cover home health care?

Medicare Advantage plans combine the benefits covered by Medicare Part A and Part B into one single plan sold by a private insurance company.

Medicare Advantage plans cover the same home health care services that are covered by Medicare Part A and Part B. Medicare Advantage plans may also offer additional benefits not covered by Original Medicare.

Call today to speak with a licensed insurance agent who can help you compare Medicare Advantage plans that are available where you live. You may be able to find a plan that covers home health care benefits covered by Original Medicare as well as additional benefits not covered by Part A and Part B.

About the author

Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.

Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.

Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.

Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.

A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.

If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.

 

 

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