Medicare Part A and/or Medicare Part B cover eligible home health services like these:
- Part-time or "intermittent" skilled nursing care
- Physical or Occupational therapy
- Speech-language pathology services
- Part-time or intermittent home health aide care (there are restrictions)
- Injectable osteoporosis drugs for women
- Durable medical equipment or medical supplies for use at home
Usually, a home health care agency must be Medicare-certified and coordinate the services your doctor orders.
Medicare doesn't pay for:
- 24-hour-a-day care at your home
- Meals delivered to your home
- Homemaker services (like shopping, cleaning, and laundry) that aren’t related to your care plan
- Custodial or personal care that helps you with daily living activities (like bathing, dressing, or using the bathroom), when this is the only care you need
All people with Part A and/or Part B who meet all of these conditions are covered:
- You must be getting services under a plan of care created and reviewed regularly by a doctor.
- You must need, and a doctor must certify that you need, one or more of these:
- Intermittent skilled nursing care (other than drawing blood).
- Physical/occupational therapy, speech-language pathology.
- You must be homebound, and a doctor must certify that you're homebound.
- You're not eligible for the home health benefit if you need more than part-time or "intermittent" skilled nursing care.
Your costs in Original Medicare
- $0 for covered home health care services.
- After you meet the Part B deductible, 20% of the Medicare-Approved Amount/covered medical equipment.
Before you start getting your home health care, the home health agency should tell you how much Medicare will pay. The agency should also tell you if any items or services they give you aren't covered by Medicare and their costs.
To find out how much your test, item, or service will cost, talk to your doctor or health care provider. The specific amount you’ll owe may depend on several things, like:
- Other insurance you may have
- How much your doctor charges
- If your doctor accepts assignment
- Where you get your test, item, or service
Your doctor or other health care provider may recommend you get services more often than Medicare covers or services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. Ask questions!
During the COVID-19 pandemic, nurse practitioners, clinical nurse specialists, and physician assistants can provide home health services, without the certification of a physician.
And if this all sounds complicated, it is. You can find out about inexpensive Short Term Home Health Care insurance here.