In some Medicare recipients’ lives, there could come a time when home health care is a necessity to continue living a quality life. But those same beneficiaries may be wondering if Medicare covers home healthcare.
The simple answer is that Medicare covers some home healthcare services. Continue reading to learn more about this subject and your options for getting coverage.
Medicare coverage for home health care
Services covered by Medicare for home health care include skilled nursing care, physical therapy, occupational therapy, speech therapy, and home health aide services.
Medicare approves home health care if you meet specific requirements:
- You must be homebound, meaning you cannot leave your home without assistance.
- Your doctor certifies that you need home health care
- Have a care plan from your doctor
- Medicare must approve the home health agency
Non-covered home health care services
Medicare doesn’t cover many home healthcare services. These services include personal care, such as bathing, dressing, and grooming.
Other services such as transportation, meals, and household chores don’t receive coverage. Most of the non-covered services are referred to as custodial care services.
Some Medicare Advantage plans provide care for some custodial care services. Check with your Medicare Advantage provider to see if the custodial services you need are covered.
Medicare-approved home health agencies
Specific requirements must be met for a home health agency to be approved by Medicare. The home health agency must be licensed in the state where it’s located and has quality assurance and patient satisfaction programs.
How does Medicare cover home health care?
Medicare Part A covers home health care from a Medicare-approved home health agency and covers 100% of the cost of covered home health care services. A Medicare-approved home health agency furnishes no copays or deductibles for home health care services.
Medicare Part B also covers home health care from a Medicare-approved home health agency. Medicare Part B covers 80% of the cost of covered home healthcare services, and the beneficiary is responsible for the remaining 20%.
Medigap coverage
Since Medicare Supplement plans pick up all or most of your portion of Medicare costs. In most cases, Part B will cover these services.
Medicare Advantage coverage
Medicare Advantage Plans must meet the same requirements as Medicare Parts A, and B. Advantage plans cover home health care services. However, the coverage may vary from plan to plan. You should contact your Medicare Advantage company for more information about home healthcare services coverage.
Qualifying for Medicare-approved home health care services
You must meet certain criteria for Medicare-covered home healthcare services to receive coverage. You must be homebound and must receive skilled nursing care regularly. This means that you need help with activities such as bathing, dressing, using the bathroom, and taking medicine.
In addition, you must have a doctor’s plan of care. The doctor’s care plan will include regular visits from a nurse or other healthcare professionals.
Medicare coverage for In-home caregivers
Medicare does not cover in-home care from a caregiver. However, there are some exceptions.
Medicare may cover in-home care from a home health aide if you receive hospice care and short-term skilled nursing care.
You should contact your insurance company for additional information about the coverage for in-home care from a caregiver.
Does Medicare cover 24-hour care?
Medicare does not cover 24-hour care because Medicare considers this type of care to be long-term.
Generally, Medicare doesn’t cover long-term care, but some exceptions are the same as those for in-home caregivers.
FAQs
How much does Medicare cover home health care?
Yes, Medicare Part A offers 100% coverage of services while Medicare Part B pays for 80% of associated services.
How do you qualify for home health care?
You must be homebound, need skilled nursing care regularly, and have a doctor’s plan of care.
Are there any limitations to Medicare coverage?
Yes, Medicare will not cover in-home care from a caregiver, 24-hour care, or long-term care.
What is the difference between custodial care and skilled nursing care?
Custodial care is the type of care provided to help you with activities of daily living, such as bathing and dressing. Medicare coverage requires skilled nursing and therapeutic services.
Will Medicare cover custodial care?
No, Medicare will not cover custodial care.
Can my family member be paid as my caregiver by Medicare?
No, Medicare will not pay family members as caregivers. Medicare will pay for a Medicare-certified home health agency that employs home health aides.
Can I get home health care if I’m not homebound?
You must be homebound to receive Medicare-approved home health care services.
Can I get home health care if I’m in a hospice facility?
If you are receiving hospice care, Medicare may cover in-home care from a home health aide.
Are you in need of help with coverage for home health care?
If you want to ensure you have full home healthcare coverage, the only way to do that is by getting a Supplemental Medicare plan. This type of Medicare coverage, also known as Medigap, will do just that — fill in the gaps in your coverage.
Our licensed insurance brokers are experts in Medicare and specialize in assisting Medicare beneficiaries with understanding the coverage options. They can also assist with choosing the plan that matches your needs and helps you enroll. All of their help is free of charge to you.
Give one of our agents a call today. Or fill out our online request form to receive the best rates in your area.
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