medicare, home health care

Does Medicare Pay for Home Health Care?

Home healthcare services can help to improve a medical condition, manage a medical condition, or help prevent a health condition from getting worse. Fortunately, Medicare does cover certain home healthcare services as long as they are approved. 

Medicare Part A and Part B cover home health services such as part-time skilled nursing care. Skilled nursing care involves any care that can only be provided by a registered nurse or licensed nurse practitioner. Original Medicare also covers home health services such as physical therapy, occupational therapy, speech-language therapy, and home medical supplies such as hospital beds, blood sugar meters, etc. 

What Does Medicare Not Cover?

While Medicare provides coverage for some home health care, Original Medicare does not cover long-term care, such as 24-hour home care, prescription drugs, and meal delivery services. Medicare Part A and Part B also do not cover personal care such as bathing, dressing, or bathroom assistance if that is the only care the beneficiary needs. 

Medicare also does not pay for home health services that are not related to the enrollee’s health, such as housekeeping, laundry, etc. Other long-term care plans may cover these services.

Medicare and Home Healthcare

To get home healthcare services under Medicare, a doctor will need to prove that you need certain home care services. For example, you must be homebound or require skilled nursing care. 

Also, you can receive home healthcare coverage if you need physical therapy, speech therapy, or occupational therapy while at home. Anything other than this may require you to look for a home health care agency that can provide the services you need. However, this may also mean you may not be covered by Medicare, especially if it’s not a Medicare-approved service.

If you are enrolled in Original Medicare, you will need to choose an agency that accepts Medicare or is approved by Medicare. Under Original Medicare, you can choose any agency that meets Medicare’s standards. After choosing a home healthcare agency, the agency will state how much is covered by Medicare and how much you are to pay out-of-pocket. 

What Will Be Covered?

Under Medicare Part A, you will get coverage for 100% of approved home healthcare services. For example, Medicare Part A covers home health services after a three-day hospital stay. However, you may have to cover 20% of durable medical equipment if you need items such as a wheelchair or a special bed. Durable medical equipment is defined as an item that is used for a medical reason, at home, and has a general lifetime of at least three years. 

If you were not admitted to a hospital previously, Medicare Part B will cover certain home healthcare services. Medicare Advantage plans also cover home health services since they combine coverage from Original Medicare. Some Part C plans may offer extra services such as transportation to doctor appointments and prescription drug coverage. 

At Temmen Insurance, we specialize in Medicare plans. For more information about how Medicare covers home health care, contact us today at 417-633-7200.

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