Does Medicare Pay For Home Health Care?

Home health care is designed to let you receive support services that let you live safely in your own home so you can achieve the highest quality of life you deserve. Overall, you can stay within the comfort of your own home while still maintaining your independence. If you are enrolled in Medicare, then it’s important to understand the coverage you may or may not receive for home health care services.

When Does Medicare Cover Home Health Care?

If you are enrolled in Medicare, you have certain criteria you must meet to qualify for home health care. You must be receiving care from a physician, have a plan of care established that you are receiving care from, and have your plan reviewed by your physician regularly. Your doctor then certifies the type of care you need.

You must also meet other criteria, such as:

  • The home health agency providing care is Medicare-approved.
  • A doctor certifies that you are homebound, meaning that it is difficult to leave your home due to illness or injury. It may also be recommended that you do not leave your home at all. If you do leave, it requires immense effort to do so.
  • To maintain your certification of eligibility, there must be documentation that a doctor or other certain healthcare professionals participated in a  face-to-face appointment within a certain predetermined time frame. The appointment must pertain to the reason you are receiving home health care services.

What Home Health Care Services Does Medicare Cover?

Once your eligibility is determined, Medicare will cover home health care services if they are reasonable and necessary for treatment or illness.

One of the services covered under your home health care insurance is treatment received from skilled nursing care. If a nurse arrives just to draw blood, the service is not covered by Medicare. Receiving care on an intermittent basis means that you may be eligible for combined services from a home health aide and skilled nursing services as long as: 

  • The services provided cannot exceed eight hours daily
  • The services provided cannot exceed 28 hours weekly, or 35 hours in certain circumstances.   
  • Other forms of home health care services covered by Medicare includes:
  • Physical or occupational therapy and speech-language pathology services.
  • Home health aide services, as long as it is deemed necessary and you are receiving aid from skilled nursing services. You will receive these services part-time from a home health aide and skilled nursing services combined. 
  • Medical social services, which help treat social or emotional issues that could hinder your treatment.
  • Medical supplies

What Does Medicare Not Cover?

Home health services that are not covered by Medicare include:

  • 24 hour-a-day at-home treatment 
  • Having meals delivered to your home
  • Homemaker services
  • Custodial or personal care

Determining what your Medicare insurance plan may or may not cover under your home health care portion of your plan can be confusing. But, with Turning 65 Solutions, we can provide you with the resources you need to better understand your coverage!

Give us a call today to discuss your Medicare options!

Turning 65 Solutions can help you plan for the future.