Recovering from a surgery or injury makes it more difficult for you to care for yourself and your health. If you’re recovering from a hip replacement surgery, for example, you may not be able to easily follow post-surgery care instructions or perform household tasks. 

Medicare covers home health aides to help you speed up the recovery process and regain independence quickly. However, there are certain eligibility requirements you’ll have to meet before Medicare provides coverage for a home health aide. 

Key takeaways:

  • Medicare covers home health aides if you qualify for home health services and need skilled nursing care. 

  • You won’t have to pay anything for home health aides with Medicare if you meet the eligibility requirements. 

  • You can only get care from a skilled nurse and home health aide for up to 7 hours a day, with a maximum of 28 hours per week. You can receive care for a total of up to 21 days.

What are home health aides?

Home health aides are trained professionals who often work alongside other healthcare professionals to provide specialized medical attention. They help people with personal care, healthcare support, and light housekeeping, and most commonly work with people who have disabilities, are managing chronic illnesses, or are recovering from injury or surgery.

Services from a home health aide can include, but aren’t limited to:

  • Help with moving around, like getting in and out of bed or a wheelchair

  • Help with hygiene and activities of daily living, like bathing, dressing, and grooming

  • Monitoring vital signs, administering medications, and other basic medical tasks (under the supervision of a healthcare professional)

  • Help with light housekeeping duties 

Does Medicare cover home health aides?

If you meet eligibility requirements, Medicare pays for home health aide services and other home health care at no cost to you. If covered, your only out-of-pocket costs for home health services will be for any durable medical equipment you need.

However, there is a cap to the number of hours and days for which you can receive care from a home health aide. We’ll go over eligibility and limitations to coverage below. 

What are the eligibility requirements for Medicare coverage of home health aides?

First, you must meet certain criteria for coverage to receive home health care. Once you meet these requirements, there are also some conditions for home health aides. 

You qualify for home health services if you’re “homebound.” This means:

  • You can’t leave your home without assistance

  • Your doctor doesn’t recommend that you leave your home due to your condition

  • Your doctor has a face-to-face visit with you certifying that you are homebound

  • Leaving your home normally requires a lot of effort 

Once you qualify as homebound, you can only receive care from a home health aide if it’s also medically necessary for you to receive part-time skilled nursing care. You must also use a Medicare-certified home health agency for any home health care for coverage.

Note that your home health aide won’t provide the following services because Medicare doesn’t cover them:

  • Meal preparation or delivery

  • Daily errands like shopping or cleaning

  • Custodial care (dressing, bathing, toileting) if it’s the only care you need

  • 24/7 care

How many hours a week can you receive services from a home health aide with Medicare?

Medicare doesn’t cover round-the-clock care for home health services from skilled nurses and home health aides. You can receive part-time services from a skilled nurse alongside a home health aide for up to 8 hours a day and for a maximum of 28 hours per week. Medicare will cover this level of care for no more than 21 days. If your doctor thinks it’s necessary, you may be able to receive additional coverage for care for a short time. 

Does Medicare cover home health aides for dementia patients?

Medicare only covers a home health aide for people with dementia if they meet all the requirements for home health services, and they need part-time skilled nursing care. The limitations for the number of hours and days covered also apply to dementia patients.

What else does Medicare cover for home health services?

If you meet the conditions for home health services, Medicare may also cover:

  • Physical therapy

  • Occupational therapy

  • Medically necessary part-time skilled nursing care

  • Speech-language pathology services

  • Social services for medical purposes

  • Injectable osteoporosis medication for women

  • Durable medical equipment and medical supplies

On a similar note, it’s important to know that Medicare doesn’t cover nursing homes, memory care facilities, assisted living, or any long-term care. Medicare Part A does cover short-term stays at skilled nursing facilities, stays at long-term acute care hospitals, and services for hospice care

It’s common for people on Medicare to have questions about their coverage! Talk to a licensed Medicare Advisor at Chapter who can answer all of your questions and help you get the most value from your coverage. Contact us at 855-900-2427 or schedule a time to chat to get support.

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