Home health care services are a part of the many valuable benefits provided by Medicare. From a 2017 report, Medicare spent over $17 million on home health services for over 3.4 million Medicare beneficiaries.
This article will look into the types of home health care services covered by Medicare, what is not covered, and the relevant parts of Medicare for different coverage options.
- What is Home Health Care?
- Which Parts of Medicare Cover Home Health Care?
- What Home Health Care Services are Covered by Medicare?
- Does Medicare Cover Skilled Nursing Care at Home?
- Does Medicare Cover Physical Therapy at Home?
- Does Medicare Cover Occupational Therapy at Home?
- Speech-Language Pathology Services
- Does Medicare Cover Medical Social Services at Home?
- Does Medicare Cover Home Health Aide Services at Home?
- Does Medicare Cover Medical Supplies at Home?
- What Home Health Care Services Are Not Covered by Medicare?
- Who is Eligible for Medicare Home Health Care Coverage?
- Out of Pocket Expenses: Deductibles & Copays
What is Home Health Care?
Like the name suggests, home health care involves a wide range of health and social services that are usually performed at a patient’s own home to treat illness, injuries, or other medical conditions.
Depending on the patient’s situation and medical care needs, home health care services can range from nursing care, laboratory functions, and social-work services. Some of the standard home health care services include:
- Doctor consultation
- Nursing care
- Physical therapist services
- Occupational therapy
- Speech therapy
- Medical social services
- Home health aides
- Homemaker services
- Laboratory services
- Pharmaceutical services
Which Parts of Medicare Cover Home Health Care?
There are four parts of Medicare medical insurance coverage:
This part covers inpatient hospital services.
This part covers outpatient medical services.
This part (often referred to as a Medicare Advantage plan) offers alternative ways to receive Medicare benefits.
This part covers prescription drugs.
These parts help in covering various services depending on the beneficiaries’ needs and budget.
Most beneficiaries choose Part A and B, often referred to as Original Medicare, because these cover essential health services and are cost effective for seniors.
Original Medicare allows a patient to visit almost all hospitals in the country. Medicare advantage options (Part C) have restrictions that may limit patients on the doctors and hospitals they can get services from. Each cover plan has its unique benefits.
What Home Health Care Services are Covered by Medicare?
Regardless of whether a patient’s condition is temporary or chronic, Medicare should pay for the following services:
- Skilled nursing care
- Physical therapy
- Occupational therapy
- Speech-language pathology services.
- Medical social services
- Home health aide services
- Medical supplies
Does Medicare Cover Skilled Nursing Care at Home?
Medicare covers part-time or intermittent in-home skilled nursing care at a patient’s residence. These services are provided less than seven days a week or less than 8 per day across a 21 day span. If the patient is at a skilled nursing facility, the services will be covered by Part A and B Medicare.
Home health care services are provided by a licensed or certified nurse, usually through a home health care agency in a patient’s own home (or sometimes at an assisted living facility). They perform activities like administering injections, training patients to self-inject, tube feedings, changing catheters, wound care, and health condition assessment.
Related: Cost of Home Health Care vs Nursing Home
Does Medicare Cover Physical Therapy at Home?
Physical therapy at home from a licensed physical therapist is generally covered by Medicare Part A and Part B. This care usually involves exercises and physical activities that are supposed to improve levels of physical activity for patients suffering from debilitating physical issues.
Does Medicare Cover Occupational Therapy at Home?
Occupational therapy in a patient’s own home or residence is generally covered by original Medicare, Parts A, and B.
Occupational therapy helps patients navigate through sensory, cognitive, and physical problems. An occupational therapist may help patients refine their motor skills by working on keenness and concentration through picking items with tweezers. They also guide their patients through normal daily activities like dressing up or cooking.
Speech-Language Pathology Services
Speech-Language Pathology is typically covered by Medicare Part B. Speech therapy involves assessing and treating communication issues or speech disorders. They also work to prevent swallowing disorders in children and adults.
A speech therapist or pathologist does activities like playing with toys and talking with kids, training the use of augmentative communication devices, and assisting in auditory processing.
Does Medicare Cover Medical Social Services at Home?
Medical social workers assist people in increasing their coping abilities by helping them do normal daily activities and facilitating social interactions and are usually covered by Medicare Part B. These services allow the people receiving them to be more independent and have more successful social interactions.
Does Medicare Cover Home Health Aide Services at Home?
A home health aide offers skilled care like nursing and therapy to assist people in coping easily. A home aide may help the patient with bathing, dressing, and other self-care activities.
Medicare only pays for a home health aide if it involves skilled care. This service is covered by Part A or Part B, depending on the circumstances.
Does Medicare Cover Medical Supplies at Home?
Original Medicare does not cover most medical supplies but may cover four wound dressings and catheters. However, Medicare Part C and D will pay 80 percent of the approved amount for special medical equipment like wheelchairs.
What Home Health Care Services Are Not Covered by Medicare?
For Medicare to pay for medical services, the patient must be under a doctor’s care and should be getting services under a plan that doctors usually review.
Medicare does not pay for:
24-hour Medical Care
Medicare pays for 8 hours per day which is the standard working hours for workers giving the various services.
Medicare does not cater for doorstep meal deliveries. Unless patients are in a skilled nursing home, they are expected to have their own resources to help them get meals.
Unless the patient is in a skilled nursing home or hospital, Medicare does not pay for household services like shopping, laundry, or cleaning services when it is the only care needed.
If custodial or personal care – also referred to as help with activities of daily living – is part of a treatment plan alongside medical care, Medicare may pay for personal care. However, if it is the only care needed, it cannot be covered. Examples include bathing, dressing, or using the bathroom.
Long-term Care Insurance is typically the best option to get help paying for custodial care.
Related: Long-term Care Insurance Costs
Who is Eligible for Medicare Home Health Care Coverage?
To be eligible for Medicare Home Health Care coverage, you must meet the following requirements:
This means that the patient should be in a state that cannot allow them to leave home without substantial effort or help from a caregiver or a medical device like a wheelchair.
Be Certified by a Doctor
A doctor or a certified medical professional working with a doctor must certify that you need any or all of the listed medical home care services. To be approved, you must be assessed by the doctor less than 90 days before or 30 days after the start of home health care.
Be Under a Care Plan
The doctor must establish and review a plan of care regularly, stating the services you need, the person to deliver, the delivery period, the required supplies, and the expected outcome.
Approved Home Health Care Agency
Medicare must approve the home health agency that is delivering the services. More information on Medicare plans’ eligibility criteria can be found on the Official Government website or the official website for Centers for Medicare and Medicaid Services (CMS).
Out of Pocket Expenses: Deductibles & Copays
All Medicare parts have out-of-pocket expenses, with various groups of people being eligible for help to cover them.
The deductible is an amount that a person pays before their plan starts covering their medical expenses. The plan deductible must be paid in full before coinsurance and copayments apply. Ordinary Medicare plans have deductibles, while other long-term care plans vary depending on the plan provider.
A copayment is paid directly to the healthcare provider to complement the main plan when receiving a service. Only Part A has a copayment in Medicare.
For Medicare Advantage and Plan D, beneficiaries may pay a copayment for various prescription drugs based on the set rules and regulations.
Medicare Advantage has a maximum out-of-pocket policy where beneficiaries pay deductibles, copays, and coinsurance up to a certain amount. After hitting the specified amount, the plan proceeds to cover all future eligible expenses in full. The 2021 out-of-pocket maximum limit is $7,550.
Uninsured persons with less than 30 quarters of coverage or those that have exhausted their entitlement are required to pay a full premium, currently capped at $471 per month. The amount has increased by $13 since 2020.
For more information on the 2021 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs, visit this website.
The following are frequently asked questions and their answers:
Does Medicare Cover Home Health Aides?
Yes, Medicare covers Home Health Aides for beneficiaries that meet the eligibility criteria. Medicare only pays for a home health aide if it involves skilled care, and this service is covered by Original Medicare plans depending on the circumstances.
Does Medicare Cover at Home Care for the Elderly?
Depending on the circumstances, Original Medicare plans may cover at-home care for elderly persons. The requirement states that the person be homebound and their health state certified by a doctor.
How Many Days Will Medicare Pay for Home Health Care?
Your Medicare-satisfied home health caregiver is paid by Medicare, a payment that covers a beneficiary for 30 days. Payment for every 30 days is based on the condition and care needs of the beneficiary. Skilled nursing care is only covered for less than seven days a week or less than 8 per day across a 21 day span.
Does Medicare Pay for In-Home Care Services?
Yes, Medicare will pay for approved in-home health care such as home health aides, skilled nursing care, physical / occupational therapy, etc. Medicare does not pay for in-home care services that do not fall in the specified scope. For example, it does not cover around-the-clock care, meal deliveries, homemaker, and personal care services.