Home healthcare can be costly, especially for older Americans whose incomes are usually not high enough to afford it. But, if you are wondering whether your Medicare plan will cover in-home care, we have highlighted everything you need to know about it. 

Does Medicare cover home health care?

Medicare covers home caregivers under your Part A and Part B benefits. If you are homebound due to an illness or injury that requires skilled health care, you are eligible for it.

Your Medicare Part A may also cover your expenses if you have spent some time in a nursing facility or hospital but still need care at home. 

Eligibility for Medicare home health care

Anyone with Original Medicare can be covered for in-home health care, but you must meet the following criteria to qualify:

1. You must be under the care of a doctor, and the doctor must certify that you are homebound. 
2. You must be getting services that are prescribed and reviewed regularly by a doctor.
3. A doctor must deem it necessary for you to receive skilled nursing care or professional therapy services. 

Home health care covered by Medicare

If you are eligible for home healthcare, Medicare will cover the cost of the following services:

• Skilled nursing care: Medicare will pay for skilled nursing care when your condition requires it. However, Medicare only covers it up to a maximum of 8 hours per day. 
• Physical therapy and occupational therapy: If your condition is deemed to require the skills of a licensed physical therapist or occupational therapist, Medicare will cover the cost of these services. You will also be covered for speech or language therapy if your doctor has deemed it effective and necessary for your condition.
• Part-time or intermittent home health aide care: Medicare will cover home health aide care such as help dressing and bathing. However, these services are only covered if you are getting other skilled care such as nursing care or physical therapy.
• Medical supplies and equipment: Under your Medicare Part B, some medical equipment may be covered, including wheelchairs, wound dressings, walkers, nebulizer equipment, and blood sugar monitors, among others. 
• Medical social services: Medicare also covers the cost of receiving counseling or social work services at home. 

Medicare home health care exclusions

Medicare home health reimbursement is subject to certain exclusions. Medicare does not cover all home health services. Exclusions include:

• Personal care services without the need for skilled nursing care like bathing or using the bathroom;
• Household services like cleaning, shopping, or laundry;
• 24-hour nursing care; 

How much does Medicare pay for in-home health care? 

Medicare pays the full approved amount of all covered home health care costs. This means that you will pay $0 for receiving any of the covered in-home health care services.

Medicare will also pay 80% of the total cost of approved medical equipment under your Plan B benefits. However, to receive this coverage, you need to have paid your Part B deductibles.

The Home Health Agency will advise you on the exact sum that Medicare will pay for your home care as well as provide information about the services that are not covered and their costs. It will give you an Advance Beneficiary Notice (ABN) for any services and supplies that Medicare does not cover.

How long does Medicare pay for home health care?

Medicare will pay for your in-home care for as long as your doctor deems the services necessary and you meet the eligibility criteria.

Home health services like skilled nursing and health aide services are only covered on a part-time or intermittent basis. This means Medicare will only pay for these services for up to a maximum of 8 hours per day and no more than 28 hours weekly.

Finding a Medicare Certified home health agency

Medicare will only pay for your home health care if you choose a home health agency that is Medicare certified to ensure they meet federal health requirements.

Before you choose a health agency, make sure that:

• The health agency is Medicare-certified;
• It offers the specific health care services that you require;
• It is recommended by your doctor or hospital;

Medicare guidelines for home health visit time

As we already know, Medicare will not cover the cost of round-the-clock skilled nursing or health aide services. You can expect a maximum of 28 hours of paid in-home care. 

In special circumstances, however, your doctor may request additional visit time of up to 35 hours a week. Of course, this is subject to approval by Medicare. Medicare has no visit time limitations for professional therapy services like physical therapy and occupational therapy.

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Does Medicare pay for home health care for dementia patients?

Medicare will pay for home health services for dementia patients just like it will for patients with other qualifying illnesses and injuries. It means that the coverage will start only if the doctors deem the services necessary, and it will be part-time.

Does home health care with Medicare have out-of-pocket expenses?

If you have Original Medicare, you will not incur any out-of-pocket costs for home health care services approved by Medicare. This is because home health care does not attract copayments or deductibles. 

However, if your in-home care requires medical equipment or supplies, these will be covered under your Medicare Part B benefits, but you need to pay 20% of the cost to be covered.

Remember that before the start of home health care, the Home Health Agency is required to give you a notice (Advance Beneficiary Notice) informing you of any services not covered by Medicare and any applicable out-of-pocket costs.