Home health care services enable a beneficiary to receive medical treatment services in the comfort of their home. Home health care is spread across many different services, so if you have Medicare you might ask “will Medicare cover everything home health care offers?”
While Medicare may not cover every service you might want at home, it covers many medical services. In this MedicareWire article, we’ll explain how Medicare covers home health care and the types of services it doesn’t cover.
Key Takeaways
- Home health care is a group of health care services provided on a part-time basis for the homebound.
- Home health care costs an average of $24 per hour, up to 35 hours per week.
- Medicare Part A will fully cover part-time skilled nursing services for home health care, as well as home health aides if you also require skilled care.
- Medicare Part B will fully cover certain outpatient care and services, but supplies such as durable medical equipment will still require coinsurance.
- Medicare will not cover custodial or personal care services if that is the only care you need.
- Your health care provider will evaluate your condition and need for home health care every 60 days, ending it if no longer necessary.
- If you feel your home health care services are being cut prematurely, you can appeal for reconsideration.
What Is Home Health Care?
Home health care is used to provide medical treatments and services for homebound patients. To qualify as homebound, your health condition must meet one of the following criteria:1Medicare.gov, “Medicare & Home Health Care“, Accessed December 15, 2021
- You cannot leave your home without the use of a wheelchair, walking equipment (canes, crutches, walkers), or special transportation equipment due to your condition; or
- You can leave your home for short periods of time for certain events, such as a doctor’s visit, a haircut, religious services, or a family event, but doing so requires significant coordination and effort.
The end goal of home health care is to help you recover and be able to function without assistance. If the condition is proving difficult to treat, home health care will also treat your condition to prevent it from getting any worse.1Medicare.gov, “Medicare & Home Health Care“, Accessed December 15, 2021
How Much Does Home Health Care Cost?
Without coverage, the average cost for home health care is about $24 per hour depending on the home health agency you go with. If you received part-time care for up to the normal 28-hour limit, you could expect an average of $672 for a week of home health care. Comparatively, if you were to receive full-time care in a residential nursing home without coverage, you could expect to pay up to $290 per day/$2030 per week.2Genworth.com, “Cost of Care Survey“, Accessed December 15, 2021
When Does Medicare Cover Home Health Care?
Original Medicare covers home health care services if you meet the following qualifications:1Medicare.gov, “Medicare & Home Health Care“, Accessed December 15, 2021
- You are currently under a doctor’s care with an established treatment plan.
- Your doctor orders a home health care service as part of your medically necessary treatment.
- The service is provided by a Medicare-approved home health agency.
- Your doctor certifies that you are homebound.
- Other health care professionals that have treated you face-to-face for the condition you are seeking home health care for must provide documentation of your condition.
You do not pay any out-of-pocket costs for Medicare-approved home health care. The only exception is any durable medical equipment (DME) you may require while under home health care. You will still pay 20 percent of the costs for any DME you need after Medicare has provided coverage for it.3Medicare.gov, “Home health services“, Accessed December 15, 2021
Medicare Part A Coverage of Home Health Care
Medicare Part A covers part-time skilled nursing care for qualifying beneficiaries.4Medicare.gov, “Skilled nursing facility (SNF) care“, Accessed December 15, 2021. These skilled nurses provide health care services when needed, such as:1Medicare.gov, “Medicare & Home Health Care“, Accessed December 15, 2021
- Administering IVs and injection drugs
- Administering feeding tubes
- Changing wound dressings
- Educating you or a caregiver on proper prescription drug use
Part A also covers part-time home health aides, but only if you are also receiving skilled care services. Home health aides help with personal care services that you are unable to perform yourself, such as:1Medicare.gov, “Medicare & Home Health Care“, Accessed December 15, 2021
- Getting dressed
- Toileting
- Bathing
For home health care, Medicare defines these part-time services as:1Medicare.gov, “Medicare & Home Health Care“, Accessed December 15, 2021
- Fewer than 8 hours each day
- 28 or fewer hours each week (or up to 35 hours a week in some limited situations)
If your condition requires more skilled nursing care or home health aid than this, it is likely your condition would not qualify you for home health care coverage in the first place.
Medicare Part B Coverage of Home Health Care
Medicare Part B covers certain outpatient services provided in your home by a qualified health care professional, including:
- Occupational therapy5Medicare.gov, “Occupational therapy“, Accessed December 15, 2021
- Physical therapy6Medicare.gov, “Physical therapy“, Accessed December 15, 2021
- Medical social services3Medicare.gov, “Home health services“, Accessed December 15, 2021
- Speech-language pathology7Medicare.gov, “Speech-language pathology services“, Accessed December 15, 2021
Medicare Advantage Coverage of Home Health Care
If you have a Medicare Advantage plan, it will provide coverage for all of your Medicare Part A and Part B benefits, including home health care. However, the amount of coverage for these services can vary between Medicare Advantage plans, which means your out-of-pocket costs may vary. If you have joined or you plan to join a Medicare Advantage plan, you should contact the plan provider for details on how it covers home health care.1Medicare.gov, “Medicare & Home Health Care“, Accessed December 15, 2021
What Doesn’t Medicare Cover for Home Health Care?
While Medicare will cover many home health care services, some important services are not covered. Services Medicare will not cover include:3Medicare.gov, “Home health services“, Accessed December 15, 2021
- 24-hour-a-day care at home
- Meals delivered to your home
- Homemaker services (like shopping, cleaning, and laundry), when this is the only care you need
- Custodial or personal care (like bathing, dressing, or using the bathroom), when this is the only care you need
When Does Home Health Care End?
Your health care professionals will evaluate your condition and make any necessary adjustments at least once every 60 days. If they determine your condition has improved to the point that home health care is no longer necessary, you will receive an Advance Beneficiary Notice of Noncoverage (ABN) declaring that Medicare will not cover any further home health care after a certain date. The home health agency providing your care will also send a similar notice, a Notice of Medicare Non-Coverage (NOMNC), two days prior to when they plan to cease providing further care services.1Medicare.gov, “Medicare & Home Health Care“, Accessed December 15, 2021
What If My Home Health Care Is Ending Too Soon?
If your home health care is ending, it is likely because you are getting better and no longer need it. But that is not always the case and you may feel that your home health care coverage is ending prematurely. If so, you can file a fast appeal to continue home health care.
When you receive your NOMNC, it will let you know when your services are ending and instructions on how to file for a fast appeal. A Beneficiary and Family-Centered Care Quality Improvement Organization (BFCC-QIO) will go over your appeal, discuss your condition with your doctor, and notify you of their decision within three days after the end date on the NOMNC.1Medicare.gov, “Medicare & Home Health Care“, Accessed December 15, 2021
Summary
Nobody wants to stay in some tedious and miserable hospital when they’re recovering from a medical condition. You’d much rather be recovering at home getting the care you need and then sleeping in your own bed. If you are suffering from a condition that will leave you unable to leave the house reliably, Medicare will provide coverage for many home health care services.
Talking to your doctor is the first step towards getting home health care for you or those you love. From there the doctor will assess your medical history and determine if you can leave home safely with your condition. If home health care is recommended by the doctor, you can then work with a Medicare-approved home care agency to get you the care you need.
If you have questions about whether certain services are covered or need help filing for a fast appeal, you can call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.
Citations
- 1Medicare.gov, “Medicare & Home Health Care“, Accessed December 15, 2021
- 2Genworth.com, “Cost of Care Survey“, Accessed December 15, 2021
- 3Medicare.gov, “Home health services“, Accessed December 15, 2021
- 4Medicare.gov, “Skilled nursing facility (SNF) care“, Accessed December 15, 2021
- 5Medicare.gov, “Occupational therapy“, Accessed December 15, 2021
- 6Medicare.gov, “Physical therapy“, Accessed December 15, 2021
- 7Medicare.gov, “Speech-language pathology services“, Accessed December 15, 2021