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Home Health Agencies and Medicare

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If you are homebound and need health care–for example, if you were recently in the hospital for an operation–Medicare might pay for health care at home. Medicare-approved home health agencies can sometimes substitute for nursing homes, usually on a temporary basis while you recover.

About home health agencies

Home health agencies give care in the home, as their name implies. People with medical conditions or disabilities sometimes get home health care services from these agencies, as an alternative to nursing home care. Services offered depend on the agency, but might include things like skilled nursing care, physical therapy, or home health aide services. Some agencies may also teach you (and your family or friends) how to care for yourself.

Your doctor or hospital discharge planner can guide you about whether you need care in the home, and where to get information about home health agencies. Many states offer limited home health services as well.

The information contained in this article is for informational purposes only. It should never be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition.

Medicare coverage

In some cases, Medicare pays for care at home through a Medicare-certified home health agency. To qualify, your doctor must certify that all of the following are true:

  • You are a Medicare beneficiary under a doctor’s care.
  • You are homebound (unable to travel outside the home without assistance).
  • You need at least one of these:
    • Skilled nursing care (besides drawing blood)
    • Physical, occupational, or speech therapy, according to Medicare restrictions and guidelines

Your doctor must order these services for you. Be aware that the doctor might order different services, or more frequent services, than Medicare pays for. Ask your provider whether you would need to pay for any of the services he or she wants you to have.

  • Your doctor must authorize and periodically review your care plan. Except for hospice care, the services you receive must be intermittent (not constant) or part-time, and be provided through a Medicare-certified home health agency.
  • In some situations, Medicare covers durable medical equipment (DME), medical social services, and other supplies or services. Your hospital discharge planner or social worker could help you identify which of your needs Medicare covers for you. You can also call 1-800-MEDICARE (1-800-633-4227; for TTY users, 1-877-486-2048) for this information. Medicare does not pay the total cost for all of these; for example, you pay 20% of DME costs. Some Medicare Supplement plans pay for some or all of your costs (the costs to you that Original Medicare, Part A and Part B, doesn’t cover).
  • You’re entitled to the same level of services whether you are a member of a Medicare Advantage plan or are enrolled in Original Medicare (Part A and Part B).

Home care that Medicare does not cover

Medicare doesn’t pay for all care in the home. For example, it doesn’t cover these services:

  • Long-term skilled nursing care
  • Personal care (such as help bathing)
  • Meals
  • 24-hour, constant care
  • Housekeeping

Caregivers as alternatives to home health agencies

An increasing number of people are finding themselves in the position of caregivers. Caregivers may take care of parents, spouses, or children with special needs. They might help with food shopping and cooking; house-cleaning; paying bills; giving medicine; bathing, dressing, and other personal care; and providing company and emotional support.

Other home health agency alternatives

There are other alternatives to home health agencies besides caregivers.

  • For older people with low to moderate incomes, some federal and state-subsidized senior housing programs may offer assistance to residents who need help with certain tasks, such as shopping and laundry. Contact your state Medicaid agency for more information.
  • There are also “assisted living” arrangements offering some services to residents who live in an assisted living facility. Such services may include cooking, laundry, or reminders to take medications. Assisted living facilities can cost thousands of dollars per month, and are generally not covered by Medicare.
  • For people who cannot live independently, but do not require nursing home services, there are board and care homes. These homes are set up as group living arrangements to meet the needs of the residents. The staff usually provides help with certain daily living activities, such as eating, bathing, walking, and toileting. Private long-term care insurance and medical assistance may help residents pay for this type of home care service. Medicare does not cover them.

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