What in-Home Health Care Does Medicare Cover?
Summary: If you need skilled home health care services from a licensed provider such as a nurse or physical therapist, Medicare Part A and/or Part B typically help cover these expenses if you meet certain conditions.
It’s common for doctors to prescribe home health care for patients who are recovering from a major illness or injury, or dealing with a serious or chronic disease.
If you have Medicare, here’s what you should know about your home health care coverage under Original Medicare (Part A and Part B), and Medicare Advantage.
What is home health care?
Medicare defines home health care as skilled medical care you receive in your home that helps you achieve the following goals:
- Recover from your illness or injury
- Regain your independence or become as self-sufficient as your condition allows
- Retain your current level of function or reduce the risk of decline
If you only need non-skilled home health care, such as help with dressing, eating, and bathing, this is generally not covered by Medicare.
Home health care can be more comfortable for patients and less stressful for families and caregivers than nursing home care.
What home health care is covered by basic Medicare?
If you need skilled home health care services from a licensed provider such as a nurse or physical therapist, Medicare Part A and/or Part B typically help cover these expenses, as long as all of the following apply:
- The doctor treating you for the condition requiring home health care creates a care plan detailing the services you need. Your doctor must see you in a face-to-face visit before creating the plan.
- Your doctor certifies that you are homebound.
- Your doctor and the agency providing home health care services both participate with Medicare.
- You need only part-time, intermittent services for a specific period of time, and these services can reasonably be expected to maintain or improve your condition.
If Medicare approves your plan for home health care, the following services are typically covered:
- In-home visits by a licensed nurse for skilled care such as wound care or tube feedings.
- Home health aide services, but only while you are receiving skilled nursing care visits.
- Physical, occupational, and speech language therapy to treat your condition.
- Medical social work visits to help you manage the emotional and social issues surrounding your condition and ongoing care.
- Approved medical supplies and durable medical equipment, as long as they are provided by an agency certified by Medicare.
Medicare covers most home health care services at 100% of the allowable charges under Part A and Part B, once you’ve met your deductible. Medicare Part B typically pays 80% of the allowable charges for durable medical equipment you need at home.
Is home health care covered by Medicare Advantage?
Medicare Advantage is another way to get your Medicare benefits. By law, Medicare Advantage plans must cover everything covered by basic Medicare Part A and Part B. Some, however, may choose to offer additional coverage for home health care.
In 2019, the Centers for Medicare and Medicaid Services (CMS) approved an expanded list of home health benefits for Medicare Advantage plans that aren’t covered under basic Medicare. These benefits include:
- transportation to and from medical visits
- meal or grocery delivery
- reimbursement for home safety devices such as bath chairs or wheelchair ramps
- aide visits for personal care or housekeeping support
- adult daycare services,
- an allowance for over-the-counter medications and devices such as thermometers or blood pressure cuffs.
These supplemental benefits may have monthly or yearly caps, such as up to $25 a month for over-the-counter medications and supplies, or up to 60 trips per year for medical visits, for example. You may need to use providers approved by your plan to qualify for the supplemental coverage.
The new benefits will be offered at no additional premium, if your Medicare Advantage plan chooses to offer them.
Medicare Advantage plans are not required to offer these supplemental benefits, and they can choose which of them, if any, they will include in their plans. But the latest from CMS demonstrates that home health care benefits covered by Medicare Advantage plans are likely continue to expand.
To find a Medicare Advantage plan in your area, enter your ZIP code on this page.