What Home Health Care is Covered by Medicare

If you have read any of my blog entries, you will see that I like home health care. I think taking care of patients in their home is generally a better and less expensive way to deliver needed care. Patients are more relaxed at home and having care come to them is much easier. I remember having to take my mother to a doctors appointment once at Memorial Hermann Hospital in Houston. Having to park, then walk through a crazy maze of buildings, using two different elevators, and then having to wait more than an hour. It was too much.

Home health care is covered by Medicare. But like everything that Medicare does, what is covered and what is not covered is complicated. Some care is covered by one part of Medicare while other care is covered by other parts of Medicare. Then you have the Advantage Plans which offer some additional services. How did we get in such a mess?

What is Covered by Medicare

Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) combined cover eligible home health services like these:

  • Part-time or “intermittent” skilled nursing care. Part-time or intermittent nursing care is skilled nursing care you need or get less than 7 days each week or less than 8 hours each day over a period of 21 days (or less) with some exceptions in special circumstances.
  • Physical therapy
  • Occupational therapy
  • Speech-language pathology services
  • Medical social services
  • Part-time or intermittent home health aide care (only if you’re also getting other skilled services like nursing and/or therapy at the same time)
  • Injectable osteoporosis drugs for women
  • Durable medical equipment
  • Medical supplies for use at home

Some of these expenses may be subject to deductibles or co-pays depending upon the specific of your Medicare or Medicare Advantage plan. It is very important that you review this each year during the re-enrollment period.

What is Not Covered by Medicare

Some home health care companies provide additional services. Be aware that these services may not be covered by Medicare. For example, Medicare does not pay for:

  • 24-hour-a-day nursing
  • Meal delivery or meal prep
  • Housekeeping services including shopping, cleaning, and laundry
  • Daily needs like bathing, dressing, or bathroom visits if this is the only reason for home health care

Important Caveats to Be Aware Of

Home health care must be administered under the direction of a licensed physician. The agency must be licensed with Medicare to provide the required services. And, the care is typically offered for only a short period of time and must be renewed by the physician overseeing the care.

In additional the physician must certify that the patient is “homebound”. Homebound means: You have trouble leaving your home without help (like using a cane, wheelchair, walker, or crutches; special transportation; or help from another person) because of an illness or injury, or leaving your home.