Medicare Answers: Is Home Health Care Covered by Medicare?

  • Originally published December 2, 2013 , last updated December 23, 2014
  • Medicare
Medicare Answers: Is Home Health Care Covered by Medicare?

This week’s Ask Roger addresses eligibility for home health care coverage through Medicare. If you have a Medicare question, email AskRoger@SeniorMarketSales.com.

Karen asks:

I noticed in the outline of coverage for a Medicare Supplement that home health care is covered by Medicare. How much does it pay, and what does it cover?

You are correct. Medicare considers home health care services as an eligible expense. In order to be eligible for services without being charged, a Medicare recipient has to meet certain conditions. Those conditions are:

  1. A doctor has both determined the need for medical care at home and outlined a plan for that care.
  2. The patient requires skilled nursing care, physical therapy, speech-language therapy, or continued occupational therapy.
  3. The patient is being cared for by a Medicare-certified home health agency.
  4. The patient must be homebound. This means that leaving home is a major effort.

If these conditions are met, Medicare Parts A and B will cover home health services such as nursing care or other therapy on a part-time or intermittent basis. Home health aides typically provide help with basic tasks such as bathing, using the bathroom, and dressing and are not usually covered by Medicare.

A person may leave home for medical treatment or short, infrequent absences for non-medical reasons, like attending religious services. You can still get home health care if you attend adult day care.

Note: Home health services may also include medical social services, part-time or intermittent home health aide services, and medical supplies for use at home, durable medical equipment, or injectable osteoporosis drugs.

In 2014, you will pay NOTHING for all covered home health visits. You will pay 20 percent of the Medicare-approved amount for Medicare-covered medical equipment.