If you are 65 or older, you may be wondering whether Medicare covers home health care costs?
When hospitalized for an illness, injury, or surgery, you may need short-term health care service support while recuperating at home. These services, known as ‘home health care,’ are typically less expensive than staying longer in a hospital or transitioning to a skilled nursing facility (SNF) and can provide care that is often more convenient and just as effective.
Home health care is different from other types of home care (such as companion or personal care) as home health care aides generally carry certifications that allow them to provide medical assistance. Moreover, physicians often recommended home health care after an illness, injury, or surgery.
What is Home Health Care?
Home health care consists of a range of health care services delivered at home. They are usually less costly and more convenient than receiving care at a hospital or skilled nursing facility (SNF). Some examples of home health care include:
- Skilled nursing care (caring for surgical wounds, giving injections, intravenous or nutrition therapy)
- Physical therapy
- Occupational therapy
- Speech-language pathology services
- Part-time or intermittent home health aide (that can help you with monitoring vitals and medication adherence)
Does Medicare cover Home Health Care?
Yes – under Original Medicare, you may be covered for short-term home health care services. To qualify for home health care under Medicare:
- A doctor must certify that you are homebound because of your condition and recommend part-time or “intermittent” skilled nursing care other home health care service listed above;
- You must be getting services under a plan of care established and reviewed regularly by a doctor who will list down the services you require and medical supplies that you need, as well as the expected results; and
- You must receive care from a Medicare-approved home health agencies (HHA)
Is Home Health Care Covered Under Part A or Part B?
Depending on the service you receive, your home health care may be covered under Medicare Part A (hospital insurance) and/or Medicare Part B (medical insurance). Eligible beneficiaries will generally pay nothing for Medicare-approved home health care services except for durable medical equipment.
Medicare Part A covers home health care if it continues any hospital care of skilled nursing facility (SNF) care. Part A will cover home health care if you have either been in a hospital for three consecutive days or stayed in an SNF. In this situation, Medicare Part A covers your first 100 days of home health care. However, you must start home health services within 14 days after leaving the hospital or SNF. Part B covers additional days beyond the first 100 days.
Medicare Part B will cover home health care if you are homebound and need skilled care, but there is no prior hospitalization. Medical supplies for home use and injectable osteoporosis drugs are also fully covered by Part B. However, if you require durable medical equipment (DME), you will need to pay your 20% Part B coinsurance.
Does Medicare Cover Long-Term Home Health Care?
Medicare does NOT cover long-term home health care and non-medical services such as:
- 24-hour-a-day home care
- Delivery of meals to your home
- Housekeeping services (cleaning and laundry), if this is the only help you need
- Custodial or personal care (personal grooming, dressing, bathroom assistance), if this is the only help you need
Does Medicare Advantage cover Home Health Care?
Yes, most Medicare Advantage (MA) plans (also known as Medicare Part C) cover home health services with the same basic coverage as Original Medicare. However, the MA plans vary in their rules, restrictions, and pricing.
You may need to check whether a specific HHA is under your plan’s network. Another thing, authorization or referrals may be necessary before you can avail of home health care. Some MA plans may even require copayments.
If you have prescription drug coverage (Medicare Part D), these could help pay for prescription drugs during your home healthcare.
Does Medicare Supplement (Medigap) Help Cover Home Health Care?
Yes, suppose you have purchased a Medicare Supplement (Medigap) plan. In that case, Medigap will help pay for home healthcare costs that Original Medicare does not cover out-of-pocket expenses (deductibles, coinsurance, and copayments). Here are some examples:
- For durable medical equipment (walkers, wheelchairs, oxygen), Medicare pays 80% of the approved amount after meeting your annual Part B deductible. Meanwhile, Medigap pays a portion or all of your Part B coinsurance (20%).
- If you stay in hospital or SNF before receiving your home health care services, Medicare covers the costs that Original Medicare does not cover. This benefit includes your Part A inpatient hospital deductible ($1,484) as well as any daily coinsurance required for an SNF stay beyond the initial free 20-day coverage provided ($185.50 per day in 2021).
How Else Can I Get or Pay for Home Health Care?
Unfortunately, Medicare does not entirely cover home health care because Medicare only covers part-time or “intermittent” skilled nursing care that your doctor deems medically necessary.
If you need long-term help at home, you can enroll in private long-term care insurance. However, since they are not under Medicare, you will have to pay on your own.
However, if you have limited income or assets, you may qualify for Medicaid, depending on your state’s rules. With Medicaid, you can access certain health care services Medicare does not cover. There are also home and community-based service (HCBS) waiver programs that offer skilled nursing care.
Does Medicare cover home health care? Yes – home health care services are covered under Original Medicare Part A and B. However, Medicare will only cover part-time or intermittent home health care. Moreover, it must be certified by your doctor or physician that you require such care. Medicare Advantage plans will also cover home health care, but it is essential to check if the home health agency is within your plan’s network.
If you are looking for long-term home care (such as companion or personal care), this is unfortunately not covered under Medicare. You will be required to pay for this 100% out-of-pocket unless you have other insurance, such as long-term care insurance.