Does Medicare cover home healthcare?
Will Medicare help pay for home healthcare services like nursing or physical therapy?
Yes, Medicare will help pay for certain home healthcare services, such as skilled nursing care and physical therapy, under specific conditions. However, coverage is limited to services that are considered medically necessary and part of a treatment plan. Here's what you need to know about Medicare's home healthcare coverage:
1. Medicare Part A and Part B Coverage for Home Health Care:
Both Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) cover home health services. Which part covers the services depends on your healthcare needs and whether you are discharged from a hospital or skilled nursing facility.
Most home health services are covered under Part B, even if you were recently discharged from a hospital or skilled nursing facility.
2. Eligibility Requirements for Medicare Home Health Care:
To qualify for Medicare-covered home health care, the following conditions must be met:
Doctor’s Certification: Your doctor must certify that you are homebound and require intermittent skilled nursing care, physical therapy, speech-language pathology services, or occupational therapy.
Homebound Status: Being homebound means that it is difficult for you to leave your home without assistance (such as a wheelchair or walker) or significant effort. Medicare requires your doctor to certify that leaving your home requires substantial effort due to a health condition.
Plan of Care: You must be under the care of a doctor, and your care must be provided according to a plan of care that the doctor creates and reviews regularly.
Medicare-Certified Agency: The home healthcare services must be provided by a Medicare-certified home health agency.
3. Services Covered by Medicare:
Medicare covers the following home healthcare services if they are medically necessary:
Skilled Nursing Care:
Intermittent or part-time care provided by a registered nurse or licensed practical nurse.
Services include monitoring vital signs, administering medications or IVs, wound care, and educating patients or caregivers.
Physical Therapy:
Therapy to help you regain mobility, improve strength, and manage pain after an injury, illness, or surgery.
Occupational Therapy:
Therapy to help you regain the ability to perform daily activities, such as dressing, eating, or bathing.
Speech-Language Pathology:
Therapy to address speech, language, or swallowing disorders.
Home Health Aide Services:
Personal care services such as help with bathing, dressing, and grooming are covered if they are part of the skilled care you are receiving. However, Medicare does not cover home health aide services if personal care is the only care you need.
Medical Social Services:
Counseling and assistance with social and emotional concerns related to your health condition.
4. Services Not Covered by Medicare:
Medicare does not cover:
24-hour home care.
Custodial care (personal care services) if that is the only care you need.
Homemaker services, such as cooking, cleaning, or shopping.
Long-term care or ongoing care for chronic conditions.
5. Cost of Home Health Services Under Medicare:
Skilled Nursing, Therapy, and Medical Social Services: Medicare covers these services at no cost to you as long as they are medically necessary and provided by a Medicare-certified home health agency.
Durable Medical Equipment (DME): If you need medical equipment (such as a wheelchair or walker) as part of your home care, Medicare Part B covers 80% of the cost. You are responsible for 20% of the Medicare-approved amount.
6. How Long Medicare Will Cover Home Health Services:
Medicare covers home health care for as long as you meet the eligibility criteria. However, the services must be intermittent and medically necessary, and your doctor will regularly review and update your plan of care.
If your condition improves to the point where you no longer need skilled nursing or therapy, Medicare will no longer cover home health services.
Key Takeaways:
Medicare Part A and Part B cover certain home health services, including skilled nursing care, physical therapy, and occupational therapy, if they are medically necessary and provided by a Medicare-certified agency.
Medicare does not cover 24-hour care or custodial care alone.
Most home health services are covered at no cost to you, except for 20% coinsurance on durable medical equipment.
For help determining whether Medicare will cover your home health care needs, schedule an appointment with a Tsunami Advisor here: Schedule an Appointment.
