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Can a Medicare Supplement Plan Help Pay for Home Health Care

Medicare Supplement Plans are designed to help you pay your out-of-pocket costs under Original Medicare (Part A and Part B). If you have Original Medicare and you need home health care services, here’s what you need to know about your home health coverage with Medicare Supplement Plans.

What home health care is covered by Medicare?

Because Medicare Supplement Plans generally only cover out-of-pocket costs for services covered by Original Medicare, it’s important to know what benefits are available under Original Medicare (Part A and Part B) for home health care.

Depending on your diagnosis, why your doctor believes you need home health care, and the type of care you need, your benefits may be covered by Part A or Part B. Generally speaking, however, Medicare will only pay for home health care services if one or more of the following apply:

  • You’re under a doctor’s care and your home health services are part of a written treatment plan.
  • Your doctor certifies that you need intermittent skilled nursing care or medical therapy services at home to either improve or maintain your condition.
  • Your doctor certifies that you are homebound.

If Medicare approves your home health care services, you generally pay nothing for them, as long as both your doctor and your home health provider participate in Medicare.

However, Medicare generally doesn’t cover homemaker services, 24-hour a day care at home, or custodial or personal care if this is the only care you need. If you need this type of care, you may pay 100% out of pocket, even if you have a Medicare Supplement plan.

Does Medicare cover the durable medical equipment I need for home health care?

Part B typically covers 80% of the cost to rent or purchase any durable medical equipment you need to use at home, as long as your doctor orders it, and you get it from a supplier that participates with Medicare.

In other words, if you need a hospital bed, patient lift, and wheelchair at home, Medicare will generally cover 80% of the cost for those items after you pay your deductible. Depending on which of the Medicare Supplement Plans you choose, your plan pays all or part of your coinsurance amount.

What home health care services do Medicare Supplement Plans cover?

If you meet the Medicare conditions for home health care, you may not have a coinsurance or copayment. Since Medicare Supplement plans may pay coinsurance or copayments, your Medicare Supplement plan may not be necessary to cover any of the costs for home health care.

On the other hand, if your doctor recommends durable medical equipment to manage your condition at home, or to assist with your home care and medical therapy, all Medicare Supplement Plans generally pay some or all of the out-of-pocket costs associated with that equipment if it is medically necessary and provided by a supplier who participates with Medicare.

Which Medicare Supplement Plans pay for home health care?

If your need for home health care doesn’t meet the criteria explained above, your Medicare Supplement plan may not pay for it. For example, if you need help bathing and dressing but no other care, your home health care is generally not considered “medically necessary” or eligible for Medicare coverage.

However, if your plan pays 100% of your Part B coinsurance amounts, and a home health service is covered under Part B, your Medicare Supplement Plan may cover 100% of your share of the cost.

Do Medicare Supplement Plans pay for home health care services not covered by Medicare?

Medicare Supplement Plan benefits are directly tied to covered expenses under Original Medicare (Part A and Part B). If a service isn’t covered by Medicare, Medicare Supplement Plans generally will not pay.

Some Medicare Advantage plans cover home health expenses not covered under Original Medicare, and in fact, in 2019 according to Forbes magazine, there is expanded coverage for home health services, including meal delivery, personal safety aids such as handrails, and transportation to and from medical appointments, available with some Medicare Advantage plans. However, Medicare Supplement Plans only work with Original Medicare. If you choose Medicare Advantage, you cannot enroll in Medicare Supplement Plans.

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