Family & Relationship

Does Medicare Cover Home Health Care?

Home health care can be an indispensable element in recovering from serious medical conditions, helping individuals regain independence, prevent future complications from their condition and manage daily tasks more effectively than they could without assistance in their home environment. But many people have questions about whether Medicare covers home health care; such as which services are covered and whether any out-of-pocket payments need to be made for specific services provided.

Medicare covers both intermittent skilled nursing and therapy home health care services as well as certain medical supplies like walkers. You may need to pay coinsurance depending on your Medicare coverage; for instance, Original Medicare requires 20% copayments on most durable medical equipment (DME) used at home after meeting its Part B deductible.

Medicare requires your physician or another medical professional who works closely with them to certify that you need intermittent occupational therapy, physical therapy and/or skilled nursing. To do this effectively and make you eligible for home health care benefits, an assessment must take place as well as an individualized care plan designed and regularly reviewed by your physician which must include services needed, frequency of services needed and any necessary providers / supplies – this certification must occur every 60 days or sooner.

Homebound status is required in order to receive home health care services, though this doesn’t mean you cannot leave the house; rather, leaving would require exertion or special equipment, with possible danger in returning safely home afterwards. You still may leave home for nonmedical activities like religious services, short drives and drives or social functions such as haircuts or birthday parties.

Medicare recipients often are told they cannot access home health services as these will not improve their condition or increase their ability to function, according to Judith Stein, executive director of the Center for Medicare Advocacy. A 2013 settlement established that Medicare can cover home nursing and therapy services that help individuals maintain their current functional level.

Your home health care agency must explain exactly which costs Medicare will and won’t cover before beginning services, and provide an Advance Beneficiary Notice of Noncoverage (ABN) detailing why Medicare won’t pay. Furthermore, this document should include instructions for filing an appeal should you disagree with their decision.

Medicare Advantage plans offered by private insurers under contract with Medicare can sometimes restrict their network of home health care providers, making it harder for you to locate one who accepts your plan. To prevent any difficulties from this happening, we advise seeking out an agency approved by your Medicare Advantage provider prior to beginning care.