Does Medicare Pay for Home Health Care?
Medicare is the primary source of payment for home health care for millions of seniors in the United States. However, coverage has specific rules, eligibility criteria, and limits. Here’s a detailed look at how Medicare covers home health care, what is included, what is not, and how to start the process for your loved one.
What Types of Home Health Care Does Medicare Cover?
- Skilled Nursing Care: Intermittent care from a registered or licensed practical nurse for medication management, wound care, injections, and health monitoring.
- Therapy Services: Physical, occupational, or speech therapy for patients who are recovering from illness, injury, or surgery and require specialized therapy to improve or maintain function.
- Home Health Aide Services: Limited personal care, such as bathing or dressing, only if the patient is also receiving skilled medical or therapy services.
- Medical Social Services: Counseling, community resources, or help adjusting to illness or injury.
- Medical Supplies: Items like wound dressings or catheters needed for home treatment. Durable medical equipment (wheelchairs, walkers, oxygen) may be covered under Medicare Part B.
Who Is Eligible?
- The patient must be under the care of a doctor and have a face-to-face meeting with the doctor about the need for home health care.
- A doctor must certify that the patient is homebound (meaning leaving home requires considerable effort or assistance).
- Care must be medically necessary and intermittent (not full-time or long-term custodial care).
- Services must be provided by a Medicare-certified home health agency.
What Medicare Does NOT Cover
- 24-hour care at home
- Homemaker or personal care services if this is the only care needed
- Meal delivery, laundry, or round-the-clock supervision
How to Start Home Health Care Through Medicare
- Get a referral from your doctor after a qualifying face-to-face visit.
- Choose a Medicare-certified home health agency.
- The agency will assess the patient at home and work with the doctor to create a care plan.
- Skilled services, therapy, and supplies are typically covered at 100% with no copay (except 20% for durable medical equipment).
How Long Will Medicare Pay?
- Coverage is for as long as the patient remains eligible and continues to meet the homebound and skilled need requirements, with recertification required every 60 days.
For more information and to see if your loved one qualifies, visit our Home Health Care for Seniors page or talk to your doctor and a local home health agency.
