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Dear Connie,
My husband has multiple chronic conditions. While we have specialists coming to the house to support him, I hope to get help with his daily personal care needs. It’s become overwhelming for me to manage. I’m wondering, does Medicare cover home health aides?
Seeking help,
Shirley from Spring Hill, Florida
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Local, licensed insurance agents with 25+ years of combined experienceDear Shirley,
Thank you for reaching out. The good news is that Medicare may cover home health services for your husband because he is already receiving skilled care at home. Here is what you need to know.
Yes, but only under specific conditions. According to Medicare.gov, Medicare Part A covers home health care services when they are part of a doctor-ordered care plan that also includes skilled nursing or therapy. A home health aide is not a stand-alone Medicare benefit.
Because your husband is already receiving skilled care, he likely meets the basic requirement. That means Medicare may cover the cost of an aide to help with his personal care at no cost to you.
Agent tip:
“Home health aides are not covered by Medicare as a stand-alone service. To qualify, the Medicare beneficiary must also be receiving skilled nursing care, physical therapy, occupational therapy, or speech-language pathology services at home.”
To qualify for Medicare-covered home health care services, your husband must meet all of the following. According to Medicare.gov, he must:
As required by CMS, a provider must conduct a face-to-face visit before services begin. His plan must be recertified every 60 days. If skilled care ends, the aide benefit ends too. When all conditions are met, aide visits are covered at no cost, with no copay or deductible.
Medicare’s home health care benefit covers part-time or intermittent care only.
Medicare does not cover 24-hour home care. If your husband needs more than 35 hours of help per week on an ongoing basis, he would not qualify for this benefit.
Medicare’s home health benefit is a medical benefit, not a personal plan of care. It does not cover:
Medicare Advantage (Part C): Many plans offer additional home care benefits beyond those of Original Medicare. Benefits vary by plan and location.
Medicaid: If your husband has limited income, Medicaid may cover personal and custodial care that Original Medicare does not pay for.
Private pay or long-term care insurance: Private agencies offer flexible non-medical support. A long-term care insurance policy may also cover some of these services.
Medicare Part A may cover a home health aide for your husband at no cost because he is already receiving skilled care at home. Coverage is limited to part-time care, up to 28 hours per week in most cases. If his needs go beyond that, Medicare Advantage or Medicaid may help fill the gaps.
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No. Medicare does not cover a home health aide as a stand-alone service. Your loved one must also be receiving skilled nursing, physical therapy, occupational therapy, or speech-language pathology under a doctor-ordered care plan. Personal care alone does not qualify.
According to Medicare.gov, a person is homebound if leaving home requires considerable effort due to illness or injury; for example, needing a walker, wheelchair, or another person’s help to get out. You can still leave for medical appointments or religious services without losing eligibility.
There is no set time limit. Medicare can continue to cover home health aide services as long as your loved one qualifies. A doctor must review and recertify the care plan every 60 days. If skilled care ends or the homebound requirement is no longer met, the aide benefit ends.
It depends on the plan. Medicare Advantage plans must cover at least the same home health benefits as Original Medicare. Many plans offer supplemental home care benefits beyond that. A licensed insurance agent can help you compare plans in your area.
A Medicare-covered home health aide works under a doctor-ordered skilled care plan. A private home care aide provides non-medical support like companionship, meal preparation, and housekeeping. Medicare covers only the first type, and only when skilled care is also provided.
Read more by William Revuelta
I am a Spanish-speaking Florida Life and Health Insurance Licensed Agent and have been helping people with Medicare since 2009. I’m an avid sports fan and enjoy watching international soccer matches and college football. When not with my family, I listen to podcasts ranging from history to sports talk.
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