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Medicare Home Health Care

Summary: Medicare home health care benefits are available to help you cover associated costs, but there are guidelines that you’ll need to be aware of. There are also different types of care, and you’ll need to know when and how you qualify for these services to avoid paying out of your own pockets. Estimated Read Time: 12 mins

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There are several reasons why you may receive home healthcare services. Many seniors can benefit from services such as therapy or skilled nursing care from the comfort of their homes, and for qualifying beneficiaries, Medicare home health care benefits are available.

But Medicare home health care benefits require qualifications and guidelines that are important to follow to qualify your care for coverage. Furthermore, while Original Medicare benefits are there for you, meaning Medicare Part A and Part B, you may incur leftover out-of-pocket expenses.

The good news is that Medicare home health care coverage can mean an improved quality of life for beneficiaries. Plus, there are also supplemental coverages available through Medicare Supplement (Medigap) plans that can keep your out-of-pocket expenses low. Learn more about Medicare in home health care and how to maximize your coverage.

Does Medicare Cover Home Health Care?

Medicare home health coverage for in-home health care is available in some instances, but there are specific situations in which your benefits apply. This includes the qualifications to determine the extent of home health care you can receive.

Original Medicare provides you with medical care, but for your benefits to cover them, they must be deemed medically necessary by your healthcare provider. Therefore, receiving Medicare home health care coverage will depend on your needs.

To cover home care services, your Medicare benefits must meet specific guidelines. It’s also worth mentioning that there are restrictions that apply. The Medicare home health care qualifications are as follows1:

  • You’re receiving healthcare from a qualifying doctor or allowed practitioner in the Medicare program, and your home health care is based on an established plan. Note: you’ll also need to use an agency that is a part of the Medicare program.
  • Your healthcare provider has determined you need at least one of the following services: physical therapy, speech-language therapy, intermittent skilled nursing care (besides drawing blood), and or specific occupational therapies.
    The home health agency caring for you is Medicare-certified.
  • Medicare home health benefits are available, but you must be determined to be homebound, meaning you can’t leave your home without assistance, or it’s not recommended to leave your home because of your health. This includes if you wouldn’t usually leave your home because of the effort unless it were for a short trip, such as a religious service, quick errand, or family event.
  • You’re under the supervision of a healthcare professional that reviews your treatment plan frequently.

Your Medicare home health services are typically covered if you qualify according to the guidelines above. These benefits come from Original Medicare coverage, and supplemental coverage is available through Medigap plans. Alternatively, Medicare Advantage plans can also help you cover related medical expenses.

What Does Medicare Pay for Home Health Care?

Home health and Medicare benefits can help provide you with appropriate coverage for medically necessary at-home care on a short-term basis. But your doctor must prescribe at-home therapy before Medicare applies. Here are some examples of what Medicare coverage for home health care covers:

  • Therapy, including physical, speech, or occupational.
  • Skilled nursing services for those who qualify.
  • In-home care you receive from your team of doctors that are available on-call 24/7.
  • Additional costs not covered by Original Medicare may also be covered. Home health care through Medicare Advantage plans can offer home meal deliveries, though these benefits vary from company to company and plan to plan.

Medicare home health care coverage can also mean covering caregivers that meet specific requirements. The amount covered for caregivers will depend on many factors, as well as the benefits provided to those taking care of a beneficiary.

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How Long Will Medicare Pay for Home Health Care?

Medicare home health care benefits will cover the costs of your services so long as they are medically necessary. But home health care from Medicare is diverse and complex, often with guidelines involving time frames. Here are some key considerations:

  • Medicare provides benefits for intermittent skilled nursing care. This means you’ll receive it less than seven days per week, less than 8 hours per day, and only up to 21 days.
  • If you require more than intermittent skilled nursing care, in most cases, you won’t qualify to have home health care coverage. There is a three-week extension available, but this is only available during exceptional circumstances.
  • Hospice is not considered home health care but can often be related. There are also benefit periods that revolve around your healthcare when you receive hospice rather than in-home healthcare.

The most significant factor in how long your home health care with Medicare benefits is covered comes down to your medical needs. Your team of healthcare providers will need to review your healthcare needs and dictate that home health care is necessary for your condition to receive an extension.

Who Qualifies as Caregiver Under Medicare Rules?

There are strict guidelines to determine who is a Medicare home health care family member or caregiver. However, coverage for in-home caregivers is available. When your parent begins to age, they may become homebound certified by their doctor. In this case, reimbursement for medical in-home services may be available as conducted by family members.

Your doctor must order rehab therapy visits or intermittent skilled nursing services to treat your condition. Although Medicare only pays for therapy short-term. Skilled care must be from a certified home health agency through Medicare. However, you don’t need to worry about Medicare approval if you have long-term care coverage.

Does Medicare Cover Home Health Care For Dementia?

Yes, Medicare home health care coverages are available for dementia patients that are determined to be homebound because of their condition. Therefore, if you are suffering from dementia, your doctor will need to designate you as homebound in order to receive home health care services. You can receive as much as 35 hours per week of services.

Does Medicare Cover 24-Hour In-Home Hospice Care?

Yes, Medicare in-home health care for hospice patients may be covered, but these situations are rare. While Medicare Part A provides such benefits, you’ll need to have these services determined as medically necessary because your health has declined so much you’re in need of continual care.

Medicare will not pay for 24-hour home health care. A home health care agency typically coordinates any services your doctor orders. Medicare doesn’t cover around-the-clock care at home or other home-maker services, nor does it cover meal deliveries to your home.

Medicare for home health care benefits can be complex when you require hospice care, but remember, Medicare Part A provides all beneficiaries with hospice care benefits. This includes having your hospice nurse and doctor available to your on-call 24 hours a day, seven days a week, so that you can always receive the care you require.

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Medicare Home Health Care Agencies

In-home services must come through a Medicare-approved home health agency. Medicare covers in-home care for seniors with personal, hands-on care for an intermittent time for beneficiaries meeting health requirements.

Home health agency services in Florida, Illinois, Michigan, Texas, and Massachusetts may offer a Medicare demonstration program. These programs give you and your home health agency an earlier idea of coverage. To find Medicare home health care agencies near you, you can use the program’s online tool to search by ZIP Code or provider.

For more information, you can contact your State Survey Agency. Responsible for inspecting and certifying home health agencies for Medicare, they can provide you with the state survey report on home health agencies near you.

Does Medicare Cover Home Health Care for Cancer Patients?

Yes, cancer patients can receive home health care Medicare benefits the same way as other beneficiaries. This means that if you’re in need of this coverage, you’ll need to follow the same guidelines and be aware that there are some costs that may remain out-of-pocket without additional coverage, such as a Medigap plan, in place.

Is Home Instead Covered by Medicare?

No, Home Instead is a private company that provides senior care services to help with various issues, but Medicare won’t generally cover their costs. The costs for Home Instead care can vary, and other insurance companies may cover their services, but Original Medicare does not. Medicare won’t cover things like live-in caregivers, Visiting Angels, or other custodial services. But, if there is a medical need for care, Medicare will pay for services at home.

To receive care for services such as Home Instead, you can enroll in Medicare Advantage plans, so long as they cover the specific service within your plan. Not all Medicare Advantage plans will offer this coverage or be available in your area, and network restrictions apply. Therefore, reviewing and comparing your options is always a good idea.

Does Medicare Advantage Cover Home Health Care?

Yes, Medicare Advantage plans cover a range of in-home care services, but you will have to deal with restrictions that come with your benefits. While Medicare Advantage plans are required to provide you with the same benefits as Original Medicare, there are still network restrictions to remember.

This means you can receive Medicare Advantage home health care services approved by Original Medicare benefits, but you may have to use certain healthcare providers to receive coverage. Different Medicare Advantage plans use various healthcare networks, and you could limit your options depending on where you live and the type of in-home care you require.

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Which Medicare Advantage Plans Cover Home Health Care?

There are over 3,800 Medicare Advantage plans available throughout the United States, and determining which is available to you will depend on various factors, including where you live and the company you enroll in.

Unlike Original Medicare benefits, which come from the federal government’s program, your Medicare Advantage benefits come from private insurance companies. Therefore, you’ll notice discrepancies among the Medicare Advantage plans available because different carriers offer different options.

The best way to pinpoint which Medicare Advantage plans cover your home health care services is to work with a licensed Medicare agent. Not only can these experts help you find the available Medicare Advantage plans in your area, but you can also compare coverage options to find the right option for your healthcare and budget needs.

Does Medicare Supplement Cover Home Health Care?

Yes, Medicare Supplement home health care coverage is available. Also known as Medigap, a Medicare Supplement plan is supplemental coverage for Original Medicare. This means once you’ve covered your benefits with Medicare Part A and/or Part B, your Medigap plan is there to help you cover any remaining costs that can occur.

On the surface, this can seem similar to Medicare Advantage, but it’s important to understand how Medicare Supplement home health care coverage differs and why it may better suit your needs:

  • You’ll receive more options for health care when enrolling in a Medigap plan. This is because there are no networks. If your healthcare provider is a part of the Medicare program, your Medicare Supplement benefits are accepted.
  • Medigap plans pick up where your Original Medicare coverage lets off and fills in the gap that would otherwise remain, leaving you to pay out-of-pocket for your services. This can help you cut healthcare costs over the long term, as there are a variety of standardized plans available.

It’s important to note that you can’t have both a Medicare Supplement and Medicare Advantage plan simultaneously. Therefore, you’ll want to assess all of your health needs and choose the option that best fits them. Remember, working with a licensed Medicare agent can help you determine which plans are available in your area while comparing them to find the right fit for your needs.

Does Medicare Cover Personal Care Services?

Although exceptions may apply when you only need personal care services, Medicare considers this custodial and doesn’t pay for these services. Personal or custodial care includes needing assistance with simple life tasks such as using the bathroom, getting dressed, or bathing. When in doubt, refer to the Medicare home health care qualifications and remember that for your benefits to cover any healthcare service, they must be deemed medically necessary by your healthcare provider.

Does Medicare Pay for Non-Medical In-Home Care?

Like personal care services, many seniors need help with daily activities like dressing, bathing, house chores, and other daily activities, but in-home care for non-medical reasons doesn’t have coverage. Families often struggle when trying to take care of their loved ones without the support of Medicare, as caregivers may provide baths on a short-term basis. However, a healthcare professional must provide these services, and a person’s health status must require home health care to be covered.

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How Do I Get Medicare To Pay for Home Care?

Several home health care Medicare options are available, and choosing the right one can make a difference in how your services are covered. Everyone has different healthcare needs, so it’s impossible to say which option is the absolute best, but you can audit your healthcare and budget needs to find the right choice.

Working with a licensed Medicare agent means reviewing your healthcare needs and identifying the best option to help cover them. For example, 12 lettered Medicare Supplement plans are available, and the right one will depend on your budget and healthcare needs.

Some beneficiaries require more coverage, such as the benefits found in Medigap Plan F or Plan G. In contrast, others may better prefer Plan N, which has a cheaper premium but fewer benefits. There are also attractive Medicare Advantage plans that may offer incentives that better fit your healthcare needs and lifestyle.

Regardless of what you need, our team is here for you to provide a personalized level of coverage to help you in the present and future meet your healthcare needs while cutting expenses. Give one of our agents a call at the number above or fill out our online rate form today to compare plans offering Medicare home health care coverage today!

Sources

MedicareFAQ is dedicated to providing you with authentic and trustworthy Medicare information. We have strict sourcing guidelines and work diligently to serve our readers with accurate and up-to-date content.

  1. Medicare & Home Health Care, Medicare.gov. Accessed April 2023.
    https://www.medicare.gov/publications/10969-medicare-and-home-health-care.pdf
Kayla Hopkins

Kayla Hopkins

Content Editor
Kayla Hopkins is an accomplished writer and Medicare educator serving as the Editor of MedicareFAQ.com. Upon completing her Communications degree from Ohio University, Kayla dedicated her time to understanding the ever-evolving landscape of healthcare. With her extensive background as a Licensed Insurance Agent, she brings a wealth of knowledge and expertise to her writing.
Ashlee Zareczny

Ashlee Zareczny

Compliance Manager
Ashlee Zareczny is the Compliance Manager for MedicareFAQ. As a licensed Medicare agent in all 50 states, she is dedicated to educating those eligible for Medicare by providing the necessary resources and tools. Additionally, Ashlee trains new and tenured Medicare agents on CMS compliance guidelines. Ashlee is a Medicare expert who specializes in Medicare Supplement, Medicare Advantage, and Medicare Part D education.

6 thoughts on "Medicare Home Health Care"

    1. Hi Roger, your father may be eligible for Plan F or Plan G. However, he cannot enroll in both. He will need to be able to pass medical underwriting to enroll in either plan, so I suggest working with a licensed agent to find the right carrier for his needs.

  1. Looking for advice on ALS and home care. My aunt can no linger use her arms and lives with an alcoholic husband who is not caring for her. She is homebound and under the care of a physician for the ALS. What services is she entitled to? She has a Port in her chest for infusion therapy for Radicava. She goes to an infusion center for 2 weeks on and 2 weeks off. Can she get this at home with home health Nurse that then would enable her to receive a home health aide for a bed and batgh service? What else can she possibel hace to enable to her to stay at home? Please respons we desperately need help.

    1. Marie, there are many types of at home infusions, however without knowing her exact treatment plan, it is hard to answer your question. I recommend speaking with her physician as they would know what the best course of action is regarding her treatment.

  2. Hi Lindsay, my mother in law suffered a major stroke very recently and we are looking to decide what Medicare plan is best for her. We still do not know what treatment will be required or the full impact of her stroke. At what point should we be making decisions on what plan to subscribe to? What information should we have in hand from her doctors before making this decision?

    1. Hi Adam! I’m sorry to hear about your mother, I’m happy she has someone to help her recover. I need a little more information to help guide you in the right direction. Does your mother have any parts of Medicare now? (Part A, Part B, Part D, or Medicare Advantage) When was your mother first eligible for Medicare? This will help us determine if she is in an open enrollment period to enroll in anything at the moment. If she missed her Initial Enrollment Period to enroll in Part A and Part B, the General Enrollment Period is now and ends March 31st. However, her benefits won’t become active until July 1st. If she does already have Part B, I would need to know her active date. That will help us determine if she can still enroll in a Medigap plan without her pre-existing condition impacting her being accepted into the plan. I would recommend giving us a call so that an agent can collect all the information needed to get you on the right track.

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