Does Medicare Cover In Home Care?

Trying to understand Medicare coverage for home health care for you or your loved one can get confusing and become overwhelming. One of the biggest concerns today regarding Medicare coverage is, Does Medicare cover home health care? We will aim to go over all points about home care services covered under Medicare. It is important to note that the home health agency should be on the Medicare certified list for services to be covered. If the agency is not on the list, you would need to pay for their services out of pocket. Also, typically Medicare will not cover a long term, full time home health aide.

Find Out if Medicare Covers Home Health Care

Yes, Medicare Covers:

Medicare coverage for home health care is provided to those that are homebound. Homebound means that you are not able to leave your home or that you require assistance to do so. You can still qualify as homebound if you wish to attend religious services, adult daycare and doctor appointments. You will also qualify for home health care services covered by Medicare if it is determined that you need skilled nursing services on an intermittent basis, meaning at least once every 60 days and once a day for up to 3 weeks.

Skilled nursing care is performed by a skilled professional or under their supervision. In addition to skilled nursing services you may also need skilled therapy services such as physical, speech and occupational services. These services are also covered by Medicare if the services are part of your doctor’s care plan along with skilled nursing services. Your doctor will confirm if you are homebound and need intermittent skilled care.

Original Medicare (Part A and/or B) will cover: 

• Part-time or “intermittent” skilled nursing care
• Physical therapy
• Occupational therapy
• Speech-language pathology services
• Medical social services
• Part-time or intermittent home health aide services (personal hands-on care)
• Injectable osteoporosis drugs for women

No, Medicare Does Not Cover:

There are home care services not covered by Medicare. The home care services not covered by Medicare include assistance with your personal daily activities, companionship, assistance with upkeep of your home, for example housekeeping, cleaning, etc. Also, If you need round the clock care at home, Medicare will generally not cover it.

Please reference the list below:

Medicare does not pay for:

• 24-hour-a-day care at home
• Meals delivered to your home
• Homemaker services (like shopping, cleaning, and laundry), when this is the only care you need
• Custodial or personal care (like bathing, dressing, or using the bathroom), when this is the only care you need. Custodial Care does not require medical skills.

Medicare Partially Covers:

Durable Medical Equipment

If you need durable medical equipment, you will typically pay 20% of the Medicare approved amount.  You may need to rent, buy or choose to rent or buy. Medicare Part B which is the Medical Insurance part of Medicare, will partially cover durable medical equipment (DME) if your doctors and DME suppliers are enrolled in Medicare. The equipment qualifies as durable which can withstand extensive use and used for a medical reason. Please keep in mind that your doctor will have to prescribe the equipment for home use. Some of the durable medical equipment covered by Medicare includes but not limited to: Blood sugar monitors, canes, commode chairs, crutches, hospital beds, wheelchair & scooters, walkers.

How to Qualify:

To qualify for home health care coverage through Medicare the services would need to be necessary for treatment of your injury or illness. You must be under the care of a doctor and have a plan of care in place which the doctor reviews regularly.  While home health care is generally covered by Medicare Part B, Part A provides coverage under certain circumstances after you are in a hospital or a skilled nursing facility. Speak with your Medicare specialist or Doctor for details regarding Part A coverage.

Requirements for Qualification: 

• Have Part A and/or Part B Medicare Insurance
• Under the care of a doctor
• Doctor certifies that you need:
• Intermittent skilled nursing care (other than drawing blood)
• Physical therapy, speech-language pathology, or continued occupational therapy services. 
• The home health agency caring for you is approved by Medicare (Medicare certified).
• Medicare has given you approval to receive care from the home health agency
• You must be homebound, and a doctor must certify that you’re homebound.
• Your condition must be expected to improve in a reasonable and generally predictable period of time, or you need a skilled therapist to safely and effectively make a maintenance program for your condition, or you need a skilled therapist to safely and effectively do maintenance therapy for your condition

Ineligibility: 

• You need more than part-time or “intermittent” skilled nursing care.
• You may leave home for medical treatment 
• You may leave home for short, infrequent absences for non-medical reasons, like attending religious services. Note: You can still get home health care if you attend adult day care.

Discuss Medicare Coverage with a Professional

It is highly recommended that you discuss Medicare coverage for home health care with a professional. He/she will determine based on your care needs the amount of coverage allotted. If you receive services from a home health agency in Florida, your home health agency, or you, may submit a request for pre-claim review of coverage for home health services to Medicare. This helps you and the home health agency know earlier in the process if Medicare is likely to cover the services.