Home Articles Does Medicare Cover Home Health Care?

Does Medicare Cover Home Health Care?

What does Medicare cover for home health care?

The Centers for Medicare & Medicaid Services lists what Part A and Part B will cover. This includes: 

  • Part-time or “intermittent” skilled nursing care
  • Physical therapy, Occupational therapy, and Speech-language pathology services
  • Medical social services
  • Part-time or intermittent home health aide services
  • Medical supplies

There are requirements you must meet in order for Medicare to cover the above. The most important one is that the care you need must warrant skilled nursing care. 

Skilled nursing care means that you require a licensed and trained nursing professional. This care must be provided by a Medicare-certified home health care agency in order to get it covered.  

The skilled nursing care must also only be needed on a part-time, or intermittent, basis. This means that you do not need care full time around the clock. Medicare limits intermittent care to mean that you either need help fewer than 7 days each week and for less than 8 hours a day.  

These services, especially therapy services, are only going to be Medicare approved if the condition being treated is able to improve. These services must also be prescribed by a doctor, who then has to re-certify the plan every 60 days, as Medicare only approves care for a 60 day period. 

Recipients also must be certified by a doctor as home bound. This does not mean that you have to be stuck in bed, but that it takes considerable effort to leave your home. 

Home health aide services, social services, and medical supplies, and occupational therapy will only be covered when you are at home if they are paired with skilled nursing care. You cannot receive coverage for them if it is all you need.  

What does Medicare not cover for home health care?

The main objective of Medicare when covering home health care is to provide beneficiaries with short-term skilled services as an alternative to recovering in a hospital or skilled nursing facility. 

Once your needs pass this main objective, Medicare is not going to pay for this care. On Medicare’s site, they list the following as what they will not pay for: 

  • 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

The most important point to take from this is if you need help with ADLs, or Activities of Daily Living, Medicare will not pay. Activities of Daily Living include eating, bathing, dressing, toileting, transferring, and continence. 

To sum it up, if your condition is not short-term, does not need skilled care, and is not expected to improve, Medicare will not pay for it. 

How much will home health care covered by Medicare cost me? 

When you have Medicare Part A and Part B, or Original Medicare, this is usually going to pay for everything but 20% of your costs. If you have a Medicare Supplement, it is built to cover this 20%. This means you should have no out-of-pockets costs besides normal deductibles and copays for Medicare approved services. 

If you are getting home health care services, the home health agency should go over what Medicare is going to pay and what they are not going to pay. 

Doctors might recommend you get services more often than Medicare covers or services that Medicare just does not cover. The home health care agency should go over how much you will have to pay for them if necessary. 

If Medicare doesn’t pay for home health care, how can I pay for it? 

Like we mentioned, most people who want home health care are not going to qualify for Medicare coverage. They are going to have to pay for the bulk of the care out of pocket. 

There are a few insurance options you can look at for covering these services, these include:

All these options must be purchased before you need care. If you are in your 50’s, 60’s, or even 70’s, it is a great time to start looking into these to prepare. 

If you are already needing care, there are still things that can be done.  Cardinal specializes in creating a plan for self-insurance, specifically for home health care. We can help you or your loved one get a plan into place for how they want to receive care and how they are going to pay for it.  

 


Listen To Finishing Well on Truth

Newest Live Episodes of Finishing Well are on The Truth Network

Finishing Well
Finishing Wellhttps://www.cardinalguide.com/finishing-well/
Retirement planning involves a lot more than just managing your money. This show is the complete guide to planning for and living in retirement, helping families finish well. Host Hans Scheil will discuss a new topic every week ranging from Social Security and Medicare to IRAs and taxes. Follow along each week by downloading the corresponding chapters below for free! New episodes air: Finishing Well Schedule on Truth Network
- Advertisment -

Recent Posts

Recapping the 2020 Election

John Rustin and Jere Royall on Family Policy Matters

Carolina Journal Radio No. 915: Returning students to in-person schooling presents urgent challenge

There’s an urgent need to return N.C. public school students to in-person instruction. That’s the message Terry Stoops hopes to send. The John Locke...

Revelation For Today (Part 9)

The Beast vs. The Lamb

Lessons from the Dungeon (Part 1 of 4)

Why do we exist? Many of us ask this question, seeking assurance that our lives have purpose and meaning. Find out how one man confronted these issues while imprisoned for a crime he didn’t commit. That’s the subject on Truth For Life with Alistair Begg.

From Hopelessness to Happiness: Keeping Your Focus on the Lord

What things are most important in our lives? Our computers probably know . . . our smartphones have a good idea. Or certainly our...

Seeing Christmas Through Women’s Eyes

Author Liz Curtis Higgs helps listeners reflect on Christmas by looking at it through the eyes of three women in the New Testament, offering...

Enoch: Fact-Checking Your Walk – Part A

In this age of information overload and misinformation, it's difficult to know which sources to trust-especially in a crisis. Fact-checking is common as we try to prove and disprove reports and then decide what to believe. Although fear and mistrust are a natural response in times of trouble, God wants us to develop a different response: faith. So what does it take to cultivate a faith that overrides fear? In this series, Skip Heitzig explores the heroes of faith in Hebrews 11 so we can learn from and follow their example. It's time to fact-check your fear with faith.

When We Wait For God Part 2

Waiting for God—it goes against our instincts. But waiting for His timing guarantees that things happen at the right time. Waiting for God means investing time every day in prayer: seeking His face and seeking His direction. In this message we disc
%d bloggers like this: