Medicare does not cover home health aides unless a doctor approves a professional home health care plan that includes skilled nursing care or physical therapy.
Medicare covers some aspects of home health services, such as physical and occupational therapy and skilled nursing care, but does not cover all services like around-the-clock care, meal delivery, or custodial care. Home health aides may fall under these services. Learn more about covered services under Medicare and how they may or may not fall under this category.
Do home health aides get Medicare coverage?
Medicare typically doesn’t cover health aide services like around-the-clock care, meal delivery, homemaker services, and personal care. However, it covers part-time or intermittent home health aide services if combined with skilled nursing care, physical therapy, or occupational therapy.
What services are covered by Medicare for home health?
Certain components of home health care are covered by Medicare Part B (medical services) and Part A (hospital services). Home health should ideally improve your care and stop you from being readmitted to the hospital.
To be eligible for home health care, you must meet a number of requirements:
- A doctor must oversee a home health care plan and review it regularly to ensure its effectiveness.
- Your doctor must certify that you require skilled nursing care and therapy services based on whether your condition will improve or be maintained through home health services.
- Your doctor must confirm that you are homebound, indicating that it is medically challenging for you to leave your home.
Medicare Parts A and B may cover home health services like part-time skilled nursing care, occupational therapy, physical therapy, medical social services, and speech-language pathology if you meet certain requirements.
How much do home health aides cost?
Your doctor will probably assist you in contacting a home health agency if they have taken the necessary actions to help you be eligible for home health services.
Through an Advance Beneficiary Notice, these organizations ought to enumerate the benefits and limitations that Medicare offers. Ideally, you will experience fewer unforeseen costs as a result.
If Medicare authorizes your home health care services, you might not have to pay anything; however, you might have to pay 20% of the cost that Medicare has approved for durable medical equipment (DME), which could include things like:
supplies for physical therapy, supplies for wound care, and assistive devices
You can normally only take advantage of complimentary services for a maximum of 21 days. If your doctor can determine when you might no longer require home health services, they may be able to extend this cap.
Medigap, or Medicare supplement plans
You might be eligible to buy a Medicare supplement plan, often known as Medigap, if you have Original Medicare (parts A and B, not Medicare Advantage).
Certain Medigap policies cover Part B coinsurance, which could assist you in covering the expense of home health care. However, additional coverage for home health services is not provided by these policies.
Since Medicare does not cover long-term care, some opt to get private long-term care insurance. Compared to Medicare, these policies might help cover more home health care services for longer periods of time. The plans do, however, differ and come at an additional expense to seniors.
The lesson learned
If your doctor approves, Medicare may pay for skilled nursing or physical therapy provided by a part-time home health aide. If you’re unsure about Medicare’s coverage, consult your doctor and potential home health agency to understand costs and duration.
