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 health care?

The simple answer is that Medicare covers some home health care services. Continue reading to learn more about this subject and what your options are in getting coverage.

What Home Health Care Services Are Covered?

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, which means that you cannot leave your home without assistance.
  • Your doctor certifies that you are in need of 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 health care services. These services include personal care, such as bathing, dressing, and grooming.

Other services don’t receive coverage such as transportation, meals, and household chores. 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

For a home health agency to be approved by Medicare, specific requirements must be met. 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. There are no copays or deductibles for home health care services furnished by a Medicare-approved home health agency.

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 health care services, and the beneficiary is responsible for the remaining 20%.

How Does Medigap Cover Home Health Care?

Since Medicare Supplement plans pick up all or most of your portion of Medicare costs. In most cases, Part B will cover these services.

How Does Medicare Advantage Cover Home Health Care?

Medicare Advantage Plans must meet the same requirements as Medicare Parts A and B. Medicare 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 health care services coverage.

Qualifying for Medicare-approved Home Health Care Services

You must meet certain criteria for Medicare-covered home health care 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.

Is 24-hour Care Covered by Medicare?

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 the exceptions 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?

No, to receive Medicare-approved home health care services, you must be homebound.

Can I get home health care if I’m in a hospice facility?

Yes, 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 make sure you have full home health care 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 of 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 help 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.

Written By:
Picture of the author
Lindsay Malzone, Lindsay Malzone is the Medicare editor for Medigap.com. She's been contributing to many well-known publications since 2017. Her passion is educating Medicare beneficiaries on all their supplemental Medicare options so they can make an informed decision on their healthcare coverage.
Reviewed By:
Picture of the expert
Rodolfo Marrero, Rodolfo Marrero is one of the co-founders at Medigap.com. He has been helping consumers find the right coverage since the site was founded in 2013. Rodolfo is a licensed insurance agent that works hand-in-hand with the team to ensure the accuracy of the content.