does medicare cover home health care

Does Medicare cover home health care?

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Dear Connie,

My father was recently diagnosed with diabetes. And he has other health conditions. My family and I are doing our best to care for his needs. As his regular caregivers, we could use some extra help to support his health and better understand how to manage his diabetes.

Someone suggested we look into home health care, but I don’t know where to start. We’re wondering, does Medicare cover home health care?

Seeking additional support,
Terry from Green Valley, Arizona

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Dear Terry,

I’m happy that you chose to reach out for help. Caregiving is a difficult task.

Based on your father’s diabetes diagnosis and possibly his other health conditions, he may be eligible for home healthcare services. I’ll help break down the eligibility and services offered in-home. These can help you decide if they may be a good fit for your father.

First, for your father to qualify for home health care, he must meet the eligibility criteria.

  • Your father would need to be under the care of a doctor or qualified practitioner, and home health care is part of a routinely reviewed care plan.
  • Your father’s doctor or qualified practitioner certifies that he is homebound.
  • The home health agency providing the care is Medicare-certified.
  • Your father’s doctor or other allowed practitioner certifies that your father needs some of the following care: intermittent skilled nursing care, physical therapy, speech-language pathology services, or occupational therapy.
  • Your father does not need full-time skilled nursing care.
  • His doctor or allowed practitioner has visited with him face-to-face within the required timeframes, and the reason was related to his need for home health care.

Once he’s under the care of a doctor or qualified practitioner who certifies he needs home health care, he may get the following services, depending on his care plan.

Agent tip:

“Home health care benefits are available for those who are homebound and under the care of a doctor or qualified practitioner. If you are a caregiver, know what support is available to advocate for care and support.“

Skilled nursing care

Skilled nursing care might be something you ask for because he has a recent diabetes diagnosis. A skilled nurse can come to his home and teach you and other caregivers about diabetes care and management.

Skilled nursing care can also include:

  • Managing, observing, and evaluating care.
  • Administering medications, including IV drugs.
  • Providing certain injections or tube feedings.
  • Changing dressings.
  • Teaching about prescribed medications or diabetes care.
  • Teaching your father and his caregivers about his care.

Medicare covers part-time or intermittent skilled nursing, meaning they come for fewer than eight hours per day and between 28 and 35 hours per week, depending on the situation. If a non-medical caregiver can safely and effectively provide a service without the supervision of a nurse, then it’s not skilled nursing care.

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  • Free, unbiased service
  • Compare all major plans and carriers
  • Local, licensed insurance agents with 25+ years of experience
Speak with a local licensed insurance agent
David Luna Co-founder and
Licensed Insurance Agent
(623) 223-8884 (TTY: 711) Monday-Saturday 8am - 8pm, Sunday 9am - 5pm
There's no obligation to enroll

Occupational therapy, physical therapy, and speech-language pathology services

Your father might be eligible to receive three other buckets of services as a home health benefit. These include physical therapy, speech-language pathology services, and occupational therapy.

These services are necessary for a home setting if they are:

  • Specific, safe, and effective treatment of the condition.
  • You can only get the services safely and effectively from a qualified therapist.
  • The condition requires therapy to restore or improve functions affected by the illness or injury, maintain the current condition, and prevent it from worsening, or the amount, frequency, and duration of services are reasonable.

Other home healthcare

Suppose your father is getting any of the above-skilled care (skilled nursing, occupational therapy, physical therapy, or speech-language pathology services). In that case, he may also be eligible for a home health aide, medical social services, and medical supplies needed during home care.

Read more about coverage and how to request a home health aide in “Does Medicare cover home health aides?”

A home health aide could help with personal care. At the same time, medical social services could support your father and caregivers with social and emotional concerns interfering with his treatment or the recovery rate. Medical social service providers can provide mental health counseling or support in finding community resources.

Durable Medicare Equipment (DME), such as a wheelchair, would be covered under Medicare Part B, not home healthcare medical supplies. You would pay the Part B deductible and 20% of the Medicare-approved amount. Medicare Part B would pay the remaining 80% of the Medicare-approved supplies.

Original Medicare Part A provides coverage for home health care. Generally, what is owed is the Part A deductible and any services or supplies that are not Medicare-approved.

Learn more about what home health care is covered by Part A by reading “What is Medicare Part A and What is Covered?

If your father is enrolled in a Medicare Advantage plan (Medicare Part C), his plan must provide the same coverage and care as Original Medicare Part A’s home health benefit.

I hope that we have answered your questions. The first step is reaching out to your father’s doctor. Now that you know your home health care options, you can advocate for his care and the caregiver support you need.

If you have additional questions, you can speak with a Connie Health licensed agent in your community. Call (623) 223-8884 for support throughout the Medicare journey.

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Frequently Asked Questions

Does Medicare cover home health care for dementia?
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Yes, Original Medicare Part A covers some home health care for dementia patients. If a doctor or other qualified professional certifies a dementia patient as homebound, the patient can receive up to 35 hours per week of home health care.

These services include skilled nursing care, hands-on care from a home health aide, physical therapy, occupational and speech-language therapy, and medical social services. If 24-hour care is needed, this would not be covered by Original Medicare Part A or B.

At a minimum, Medicare Advantage plans must provide equal coverage to Medicare Part A and B coverage for home health care for dementia.

If you have questions about home health care for a loved one with dementia, call (623) 223-8884 to speak with a local licensed agent in your community.

What does Medicare cover for home health care?
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Original Medicare Part A home health care covers skilled nursing care, physical therapy, occupational therapy, speech-language therapy, home health aides, medical social services, and medical supplies. All services must be part of a home health care plan certified by a doctor or other qualified professional. And care is limited to 35 hours per week.

Medicare Advantage plans include Medicare Part A coverage and must provide equal coverage to Part A. Therefore, if enrolled in a Medicare Advantage plan, you likely have home health care coverage and more.

Not sure about Medicare coverage for your specific situation? Call (623) 223-8884 to speak with a local licensed agent in your community.

Does Medicare cover home health care for cancer patients?
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Yes, Original Medicare Part A pays for some home health care for cancer patients.

A cancer patient can receive up to 35 hours of weekly help at home. This help may include nurses, aides, physical and speech therapy, and more. If you need 24-hour care, Original Medicare Parts A or B does not cover this.

Medicare Advantage plans also provide home health care for cancer patients. They are required to provide the same coverage as Medicare Part A, at minimum.

If you have questions about care for someone with cancer, call (623) 223-8884 to speak with a local licensed agent who can help.

How many hours of home health care does Medicare cover?
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Original Medicare Part A covers fewer than eight hours per day and 28 hours of home health care per week. In some cases, coverage for 35 hours per week is possible. The doctor or qualified professional coordinating the home health care plan will determine the weekly hours.

Medicare Advantage plans provide at least 35 hours per week under similar coverage to Medicare Part A. You may find that you have more coverage for home health care with a Medicare Advantage plan versus Original Medicare.

If you have questions about Medicare coverage for your situation, don’t hesitate to call (623) 223-8884 to talk with a local licensed agent in your community.

Does Medicare pay for home health care?
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Yes, Medicare does cover home health care, but certain conditions must be met. Medicare Part A hospital insurance and Part B medical insurance provide coverage for eligible home health services if you meet all of the following requirements:

  • Your doctor prescribes care: Your doctor must certify that you need one or more of the covered services, such as skilled nursing care, physical therapy, or occupational therapy.
  • You are homebound: This means you have difficulty leaving your home due to a medical condition and require considerable effort.
  • You receive services from a Medicare-approved home health agency.

Covered services include skilled nursing care, physical therapy, speech-language pathology, occupational therapy, medical social services, and part-time home health aide services. Medicare typically does not cover 24/7 care or custodial care, such as meal preparation or personal care assistance, when this is the only service required.

If you require Durable Medical Equipment covered under Original Medicare Part B, you will pay the annual deductible and 20% coinsurance. Part B would cover 80% of Medicare-approved products and services costs.

Medicare Advantage plans also pay for home health care. These plans are required to provide equal coverage to Medicare Part A and B, at minimum. You may find that a Medicare Advantage plan offers better home health care coverage.

If you have additional home health care questions, call (623) 223-8884 to speak with a local licensed agent in your community.

How long will Medicare pay for home health care?
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Medicare covers home health care services as long as you meet the eligibility requirements: your doctor certifies you need one or more covered services, you are homebound, and you receive services from a Medicare-approved home health agency.

Medicare only provides coverage if you show ongoing medical need and improvement. For example, coverage may end if skilled therapy or nursing is no longer required.

Medicare Advantage plans must be equal to Original Medicare and provide equal eligibility and duration for home health care coverage. However, you may find that the duration that you can have home health care coverage may be longer with a Medicare Advantage plan.

If you have questions about home health care, call (623) 223-8884 to speak with a local licensed agent in your community.

Will Medicare pay for home health care?
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Yes, Medicare can cover home health care services, but specific requirements exist to qualify.

Medicare Part A hospital insurance and Part B medical insurance may pay for home health care if the following conditions are met:

  • Your doctor certifies the need for at-home skilled care, such as nursing or therapy services.
  • You must be homebound, meaning leaving your home requires considerable effort and assistance.
  • A Medicare-approved agency must provide the home health services.

Medicare Advantage plans provide equal coverage to Medicare Part A and B, which means that you will have, at minimum, equal home healthcare coverage as Original Medicare. Oftentimes, however, you may find that your coverage is enhanced with a Medicare Advantage plan.

Have questions about whether Medicare will pay for your home health care? Call (623) 223-8884 to speak with a local licensed agent in your community.

What part of Medicare covers in home health care?
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Original Medicare Part A provides coverage for home health care. Generally, what is owed is the Part A deductible for any services or supplies that are not Medicare-approved. Medicare Part B will cover any Medicare-approved Durable Medical Equipment (DME), but you would pay the Part B deductible first, then 20% coinsurance on any approved products or services.

Medicare Advantage plans provide equal Medicare Part A coverage. You may find that with a Medicare Advantage plan, you get more coverage for home health care than with Original Medicare Part A.

Are you wondering if your Medicare plan covers home health care? Call (623) 223-8884 to speak with a local licensed agent in your community.

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Read more by Sammy Menton

I am an Arizona Life and Health Insurance Licensed Agent and have been helping people with Medicare since 2009. I enjoy coaching youth and high school sports, watching sports, and spending time with family. I also like taking road trips and vacationing anywhere that has a beach.

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