Does Medicare Cover Home Health Aide Services?
Dec 22, 2021
Medicare covers home health services. Depending on the circumstances, Part A or Part B provides coverage. However, beneficiaries must meet eligibility criteria.
Home health primarily involves helping a person receive care in their own home instead of the hospital when it is appropriate.
In many cases, home health costs less and is just as effective as care that a person may otherwise receive in a skilled nursing facility (SNF) or hospital.
For Medicare to pay for home healthcare, a Medicare-certified home health agency must provide the service. People who receive services from a noncertified home health agency will need to pay the costs out of pocket.
In this article, we explain the coverage of home health services under Medicare.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
Deductible:This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
Coinsurance:This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
Copayment:This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
What home health services does Medicare cover?
Medicare covers a variety of home health services for as long as it is reasonable and deemed necessary to treat an injury or illness.
Medicarecoversup to 8 hours of care a day for a maximum of 28 hours a week. For some people, the insurance program pays for up to 35 hours a week of home health. Medicare assesses the need for 35 weekly hours of care on a case-by-case basis.
Medicare covers the following services:
Rehabilitation therapy
Rehabilitation services help an individual regain daily function and improve their ability to live independently every day.
These services may include physical, occupational, and speech therapy.
Medical supplies and equipment
Medicare Part B covers certain medical supplies that are necessary for home health services. A doctor must prescribe the equipment for Medicare to provide coverage.
Medical supplies and equipment that Medicare covers may include:
canes
infusion pumps
walkers
wheelchairs
hospital beds
blood sugar testing strips and monitors
nebulizer equipment
traction equipment
wound dressings and supplies
Medicare covers the cost of medical equipment for home use in a few different ways, depending on the type of supplies or equipment.
For example, Medicare pays rental costs for certain types of equipment. Patients may choose to buy the equipment, in which case, Medicare also covers the cost.
Medical social services
These services involve assistance from a social worker or counselor. They can help people deal with emotional issues that may be presenting barriers to recovery from an illness or injury.
Skilled nursing care
Medicare Part A also covers the provision of skilled nursing care through home health if it is intermittent or part-time.
Intermittent nursing involves under8 hoursof care a day for 21 days or, in some circumstances, up to 35 days. It can also refer to nursing care that a person receives on fewer than 7 days of the week.
Medicare does not cover skilled nursing care that requires more than 8 hours a day or is not intermittent.
A registered nurse or licensed practical nurse must provide skilled nursing during home health services for Medicare to pay. Home health skilled nursing care may include:
wound care and dressing changes
tube feedings
administering intravenous (IV) drugs
education in disease management
Home health personal care
Home health aides provide personal care, such as help dressing and bathing.
Medicare only pays for a home health personal care aide when an individual also receives skilled nursing care or rehabilitation services through home health. Medicare does not cover home health personal care aides as a stand-alone service.
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