Does Medicare Cover Home Health Care?
We receive many questions about every topic related to Medicare. One common question is whether or not Medicare pays for in-home healthcare services.
The short answer is yes—Medicare does cover home health care. However, you must meet eligibility requirements to receive coverage. When covered, Medicare only provides part-time care, and there's a maximum number of days and hours for which you can receive coverage.
We’ll discuss Medicare’s coverage for home health care in detail, so you’re not surprised by limitations or out-of-pocket costs.
Key takeaways:
Medicare covers home health care, but only for short-term periods.
Medicare coverage for home health services includes physical therapy, skilled nursing care (coupled with a home health aide), and medical devices.
You’ll only pay for medical equipment if you need home health care services.
What is home health care?
Also known as in-home health care services, home health care refers to medical care or assisted care for anyone who needs additional support to live safely in their homes. Home health care services are generally for people recovering from surgery or injury. Some common examples of home health care services include:
Skilled nursing care like medication administration and monitoring vital signs
Speech therapy
Light housekeeping
What does Medicare cover for home health care?
Medicare covers a variety of services for home health care if they are medically necessary. Covered services include:
Part-time skilled nursing care
Part-time home health aides if you’re also getting skilled nursing care
Physical therapy and occupational therapy
Speech-language pathology services
Medical social services (like counseling and help with community resources)
Injectable osteoporosis drugs for women
Medical equipment and devices
Medical supplies like bandages and wound care
Limits to Medicare coverage for home health care
It’s important to remember that you are not eligible for home health coverage from Medicare if you need more support than you’d receive from part-time, skilled nursing care. You can receive skilled nursing care and care from a home health aide for no more than eight hours a day and 28 hours per week for a maximum of 21 days.
Medicare also doesn’t cover:
Meal delivery
Hiring an aide to help with chores (like grocery shopping or cleaning)
Custodial care (grooming, bathing, or dressing) if it’s the only care you need
What are the eligibility requirements for home health care coverage from Medicare?
Only certain people are eligible for home health care services. You must meet all of the following conditions to receive coverage:
A doctor determines that you’re “homebound,” and leaving your home may be too difficult due to an illness or injury.
You had a face-to-face visit with your doctor certifying that you need home health services.
You use a Medicare-certified home health agency.
What are your out-of-pocket costs for home health care?
If you meet the conditions above and don’t require long-term care, you’ll pay nothing for covered home health care services. Your only out-of-pocket costs will be for any medical equipment you need while receiving home health care. If you have Original Medicare, you’ll pay the standard 20% coinsurance for equipment you need. A Medicare Supplement plan will reduce your costs.
Does Medicare Advantage cover home health care?
Every Medicare Advantage plan is required to provide the same level of coverage that Original Medicare does. That means Medicare Advantage plans do cover home health care. The only thing that’s different is your out-of-pocket costs. Medicare Advantage plans vary with copays, coinsurance, and deductibles, so you may pay more for home health service with these plans than with Original Medicare. Medicare Advantage plans may also require prior authorization for covered services. Learn more about Medicare and prior authorization.
Check with your individual Medicare Advantage policy to see how much your out-of-pocket costs could be for home health care.
Does Medicare cover home health care for dementia?
Unfortunately, Medicare doesn’t cover home health care for a long period of time. If a doctor recommends home health care services for a person with dementia, they’ll only receive short-term care. However, Medicare does cover treatment, occupational therapy, doctor visits, and other services to manage dementia and slow its progress.
Does Medicare cover home health care for cancer patients?
Medicare will only cover home health care for cancer patients for a short period of time. That said, Medicare provides comprehensive coverage for cancer treatment and management.
Other important benefits Medicare covers
While there is a limit to how many hours of home health care Medicare will cover, Medicare can provide other important benefits for people who need extra assistance. Below are a few examples:
Some Medicare Advantage plans provide transportation services to the doctor or the grocery store.
Some Medicare Advantage plans provide caregiving services (e.g., Papa Pal).
Medicare provides home dialysis training for caregivers.
Get in touch with a Chapter Medicare Advisor to understand all of your Medicare benefits. Get in touch with an agent at 855-900-2427 or schedule a time to chat.