Home health services are generally covered by Medicare for those who meet certain requirements.
Medicare covers most home healthcare services, including certain therapies and home health aides. You will need to meet some requirements in order to be eligible for coverage. You’ll also be responsible for a portion of the cost for certain services.
What home care services are included in Medicare?
Original Medicare, which includes Medicare Part A and Medicare Part B, covers eligible services such as:
- Skilled nursing (part time, intermittent only).
- Part-time, intermittent home health aides
- Physical therapy.
- Occupational therapy.
- Services for medical social assistance
- Speech-language pathology services.
- Women can inject osteoporosis medications.
- Medical equipment and supplies for home use that is durable
These services are also covered by Medicare Advantage plans, which are offered by private insurers that contract with the federal government, though additional network restrictions may apply.
These services are generally not covered:
- Home care available 24 hours a day
- Personal/custodial care, such as bathing, dressing and toilet assistance (if you only require this type of care).
- If you only require domestic services, such as cleaning, laundry, or shopping (if that is what you require),
- Meal delivery.
What are the cost?
If you meet certain criteria, Original Medicare will cover eligible home care services at no charge to you. You will need to pay a portion of the cost for any other services.
- 20 percent of Medicare-approved costs for speech-language pathology, occupational therapy, and physical therapy.
- Eligible durable medical equipment (wheelchairs/walkers, crutches etc. ): 20% of the cost.
If you have not yet met your Part B deductible, it will apply to both.
A larger portion of that coinsurance may be covered if you have a Medigap policy, which provides supplemental coverage to Original Medicare. Additional restrictions and costs might apply to Medicare Advantage plans.
Depending on where you live, home health services costs may vary greatly. According to the U.S. Department of Health and Human Services, the national average cost of hiring an aide in health was $20.50 an hour in 2016.
Home health care coverage eligibility requirements
You must meet the following conditions to be eligible for Original Medicare home health services:
- A doctor must take care of you. A doctor should review your plan of care regularly to ensure that it is accurate.
- Your doctor must sign off that you are homebound. It doesn’t mean that you can’t leave your home ever; it just means that you find it difficult or require special equipment to get out. If you travel for a doctor’s appointment or other non-medical reasons, such as for a walk or drive, for weddings, graduations, funerals, or any other family event, you won’t be denied coverage.
- Your doctor must verify that you need home services. Your doctor must create a care plan which includes the services you require to be covered. Your doctor must create a care plan that includes services such as speech-language pathology, physical therapy, and continued occupational therapy. These services must be considered specific, safe, and effective for your condition. They must also be provided by a Medicare-certified agency.
Before you begin receiving services, the home health agency that you work with should inform you of how much Medicare will cover.
When should you enroll?
If you’re eligible for Medicare when you turn 65, you can enroll for it in the seven-month period starting three months before your 65th birthday. This is the initial enrollment period.
If you are already receiving Social Security benefits or Railroad Retirement Board benefits, your enrollment in Medicare Parts A & B will be automatic the day after you turn 65.
Outside of the initial enrollment period, you can also sign up or change plans during certain designated enrollment periods.