Which Home Health Care Is Covered By Medicare
Medicare covers services that include intermittent skilled nursing care, therapy, and care provided by a home health aide to people who are homebound . Home health aide provides medical care and helps with medications, braces, and other medical equipment. It can also provide a higher level of skilled nursing.
Depending on your eligibility, you can receive Medicare home health care coverage under Part A or Part B . Medicare pays the full cost of home health care under both plans.
Home health care is normally covered by Part B. Under Part B, you need to be homebound and need skilled care to qualify for home health care. Under Medicare Part B, there is no prior hospitality requirement.
Under Part A, you are eligible for home health care coverage in certain circumstances after you spend at least three days in a hospital or have a Medicare-covered stay in a skilled nursing facility. In this case, Part A will cover the first 100 days of your home health care.
Nevertheless, you still need to meet certain eligibility requirements, such as being entirely confined to your home and needing skilled care. Also, you must receive home health services within 14 days of your hospital or skilled nursing facility to receive home health care under Medicare Part A.
How Much Does Private Home Care Cost
The cost of private home care depends on several factors, in the first place, on the number of hours the designated care worker spends with you. It also depends on the kind of services and the supplies needed to assist you with your condition.
Every U.S. state has its own median cost of private home health care. However, the national average is around $4,000 per month, while an average hourly rate nationwide comes to around $20 dollars.
What Are The Costs
Original Medicare covers eligible home health care services at no cost to you if you meet certain requirements. But for other services, you’ll have to share the costs:
Physical therapy, occupational therapy or speech-language pathology: You pay 20% of the Medicare-approved costs.
Eligible durable medical equipment : You pay 20% of the costs.
In both cases, your Part B deductible also applies if you haven’t yet met it.
A larger portion of that coinsurance may be covered if you have a Medigap policy, which provides supplemental coverage to Original Medicare. With a Medicare Advantage plan, additional restrictions and costs may apply.
Home health services costs can vary dramatically depending on where you live. The national average cost of hiring a health aide was $20.50 per hour in 2016, the most recent data available, according to the U.S. Department of Health and Human Services.
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Home Health Services Covered By Original Medicare
If youre eligible for Medicare-covered home health care, services covered may include:4
- Part-time or intermittent skilled nursing care
- Physical therapy
- Part-time or intermittent home health aide services
- Injectable osteoporosis drugs for women
Note: Medicare will not pay for 24-hour-a-day care or meals delivered to your home. It also wont cover homemaker, custodial or personal care if thats the only care you need.5
How To Pay For In
There may be times when not every part of your in-home care is covered. We already know 20 percent of the durable medical equipment needed to treat you is your responsibility, but there are other services like custodial care or extra round-the-clock care that wont be covered by Medicare. This is where supplemental insurance comes in.
You may have already heard of Medigap insurance, which you purchase to help pay for all the medical costs that Medicare doesnt, like copayments, deductibles, and premiums. Its also a useful source to have when it comes to in-home care. Supplemental insurance could help cover the costs that you may accrue, like personal care, meals delivered to your home, and the remaining costs of your DME.
If you have any questions regarding your in-home care and what is covered by Medicare, contact your local Social Security office.
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Iv Getting Started With Medicare
Medicare is a federal program that provides health insurance for most Americans over the age of 65, and younger adults with qualifying conditions. Like most health insurance programs, Medicare covers some, but not all, health care expenses. As discussed above, Medicare does not cover in-home care for those who need personal care assistance, but it may cover home health care in qualifying situations.
Read on if youre unsure if youre eligible for Medicare or how to sign up for Medicare.
Medicare Part A Coverage
Part A, in contrast, does provide home health care coverage in some situations. A hospital or skilled nursing facility stay triggers Part A. If a person has a three-day inpatient stay at a hospital or has a Medicare-covered SNF stay, Part A will cover up to 100 days of home health care.
Note that a person must still meet the other eligibility requirements to receive home health care, such as needing skilled care, being homebound, and having a doctor certify that such care is necessary. A person also must receive home health services within 14 days of being discharged from a hospital or SNF. If a person doesnt meet all of the requirements for Part A coverage but is otherwise eligible for home health care benefits, her care will be financed under Part B.
Regardless of whether Part A or Part B covers a persons care, Medicare will pay:
- the entire approved cost of all covered home health visits
- 80 percent of the Medicare-approved amount for durable medical equipment
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What Does Home Health Care Include
Many people require medical assistance after the age of 65. Home health care includes medical care services in your home that you receive for illness or injury.
Home health care includes services such as intermittent skilled nursing, occupational therapy, physical therapy, and speech therapy. Home health care is typically carried out by licensed therapists, nurses, or home health aides who work for hospitals, home health agencies, or public health departments licensed by the state.
Medicare And Home Health Care
If you need skilled nursing care, some kinds of therapy, hospice, or other services in your home, Medicare may cover those home health services. If you need custodial care, however, Medicare probably won’t pay for it.
Read on to find out how much Medicare will pay for, how to qualify for home health care coverage, and what to do if the services you need aren’t covered.
Call a Licensed Agent:
Home health care could be a key part of social distancing for Medicare beneficiaries. Receiving medical care at home can prevent the spread of coronavirus and free up hospital bed for critical patients.
Ask your home health care provider about the precautions their workers are taking to guard against COVID-19 and protect their workers and patients.
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Medicare Advantage Plans Can Cover Home Health Care Services
Medicare Advantage plans combine the benefits covered by Medicare Part A and Part B into one single plan sold by a private insurance company.
Medicare Advantage plans cover the same home health care services that are covered by Medicare Part A and Part B.
Some Medicare Advantage plans may offer an expanded list of benefits that include:
- Transportation to doctor’s appointments
- Grab bars in home bathrooms
- Healthier food options
- Air conditioners for people with asthma
- Home-delivered meals
- Home health aides to help with daily activities like dressing or eating
- Caregiver support services
Find Medicare Advantage plans that cover home health care
Or call 1-800-557-6059TTY Users: 711 to speak with a licensed insurance agent. We accept calls 24/7!
About the author
Christian Worstell is a licensed insurance agent and a Senior Staff Writer for MedicareAdvantage.com. He is passionate about helping people navigate the complexities of Medicare and understand their coverage options.
His work has been featured in outlets such as Vox, MSN, and The Washington Post, and he is a frequent contributor to health care and finance blogs.
Christian is a graduate of Shippensburg University with a bachelors degree in journalism. He currently lives in Raleigh, NC.
Where you’ve seen coverage of Christian’s research and reports:
How Long Will Medicare Pay For Home Health Care
A home health agency must give a beneficiary a written Home Health Change of Care Notice when the patients plan of care is changing because the home health agency makes a business decision to reduce or stop providing some or all of the home health services or supplies.
The persons doctor has changed the persons orders, which may reduce or stop certain home health care services or supplies that Medicare covers.
For example, the agency issues an HHCCN when the doctor changes the plan of care from five days a week to three days a week. The beneficiary must be notified in writing of the change of service.
The HHCCN lists the services or supplies that will be changed and gives the beneficiary instructions on what to do if she does not agree with the change.
The home health agency is not required to give a person an HHCCN when a Notice of Medicare Noncoverage is issued.
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Who Can Receive Home Care Covered By Medicare
Individuals must have coverage through Medicare Part A and/or Medicare Part B and meet the following four criteria as set forth by Medicare.gov:
How Much Does Medicare Pay For Home Health Care
The average hourly cost of home health care in Arizona is $23.25, and it is normally less expensive than the care you would receive in a hospital or skilled nursing facility. Statewide, the cost of non-medical home care ranges from $16 $28 per hour. Medicare covers 100% for skilled health-care services as long as you are homebound.
However, Medicare wont cover for home aides that help with household services and personal care . Also, Medicare doesnt cover long-term care for conditions like Alzheimers or cancer.
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Does Medicare Pay For Home Health Care For Dementia Patients
Medicare covers some types of home health services, such as intermittent skilled nursing care as well as physical, occupational, and speech therapy. But, Medicare only covers services that a doctor orders at a certified home health agency.
Medicare wont cover:
- Help with shopping, laundry, or errands
- Round-the-clock care
Find A Home Health Care Provider
You can search for a provider by using the online home health care provider tool at Medicare.gov. Just enter your zip code and the tool will give you a list of home health care providers in your area. You can also ask your doctor, hospital social worker or discharge administrator to arrange for a home health provider in the event you need home care after a hospital stay.
Dont let an injury or illness prevent you from getting the help you may need. Talk to your doctor and ask if you qualify for home health care.
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What Does Medicare Not Cover For Home Health Care
The main objective of Medicare when covering home health care is to provide beneficiaries with short-term skilled services as an alternative to recovering in a hospital or skilled nursing facility.
Once your needs pass this main objective, Medicare is not going to pay for this care. On Medicares site, they list the following as what they will not pay for:
- 24-hour-a-day care at home
- Meals delivered to your home
- Homemaker services , when this is the only care you need
- Custodial or personal care , when this is the only care you need
The most important point to take from this is if you need help with ADLs, or Activities of Daily Living, Medicare will not pay. Activities of Daily Living include eating, bathing, dressing, toileting, transferring, and continence.
To sum it up, if your condition is not short-term, does not need skilled care, and is not expected to improve, Medicare will not pay for it.
Qualifying For Home Health Coverage
To be eligible for Medicare home health benefits, you must meet all of these conditions:
- You are homebound. That means you are unable to leave home without considerable effort or without the aid of another person or a device such as a wheelchair or a walker.
- You have been certified by a doctor, or by a medical professional who works directly with a doctor , as being in need of intermittent occupational therapy, physical therapy, skilled nursing care and/or speech-language therapy.
- That certificationarises from a documented, face-to-face encounter with the medical professional no more than 90 days before or 30 days after the start of home health care.
- You are under a plan of care that a doctor established and reviews regularly. The plan should include what services you need and how often, who will provide them, what supplies are required and what results the doctor expects.
- Medicare has approved the home health agency caring for you.
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Does Medicare Cover Home Health Care
In 2017, Medicare spent $17.7 million on home health services for 3.4 million beneficiaries, more than double the amount expended in 2001, according to the federal Medicare Payment Advisory Commission.
To be covered, the services must be ordered by a doctor, and one of the more than 11,000 home health agencies nationwide that Medicare has certified must provide the care. Under these circumstances, Medicare can pay the full cost of home health care for up to 60 days at a time.
That period is renewable, meaning Medicare will continue to provide coverage if your doctor recertifies at least once every 60 days that the home services remain medically necessary.
How Can I Get Help Paying For A Caregiver
If you or your loved one have exhausted your financial resources paying for in-home caregivers, you may be eligible for both Medicare and Medicaid.
Every state has at least one home- and community-based health services waiver program. If you meet the eligibility guidelines, this type of waiver program could help you pay for things like:
- adult day care
- help with daily personal care
- modifications to your home
- help with housekeeping
If you think you or someone in your family might need custodial care, you may want to consider a long-term care insurance policy to help you cover the cost.
A Medicare supplement plan may also help you pay some of the costs that Medicare wont cover.
If Medicare Doesnt Pay For Home Health Care How Can I Pay For It
Like we mentioned, most people who want home health care are not going to qualify for Medicare coverage. They are going to have to pay for the bulk of the care out of pocket.
There are a few insurance options you can look at for covering these services, these include:
All these options must be purchased before you need care. If you are in your 50s, 60s, or even 70s, it is a great time to start looking into these to prepare.
If you are already needing care, there are still things that can be done. Cardinal specializes in creating a plan for self-insurance, specifically for home health care. We can help you or your loved one get a plan into place for how they want to receive care and how they are going to pay for it.
Where To Look For Home Health Care Options
Start by asking your primary care physician for a recommendation, suggests Prather. Theyll likely have good resources and referrals for you. From there, broaden the conversation and ask trusted friends and family members for their recommendations. Finally, look up potential providers online and read other patients reviews.
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Does Medicare Cover Home Instead
Home instead is a private company that provides senior care services to help with a variety of issues. The costs for Home Instead care vary some insurance covers home care, Medicare doesnt.
However, if there is a medical need for care, Medicare will pay for services at home. Medicare wont cover things like live-in caregivers, visiting angels, or other custodial services.
Medicare Coverage: What Costs Does Original Medicare Cover
Heres a look at the health-care costs that Original Medicare may cover.
If youre an inpatient in the hospital:
- Part A typically covers health-care costs such as your care and medical services.
- Youll usually need to pay a deductible .
- You pay coinsurance or copayment amounts in some cases, especially if youre an inpatient for more than 60 days in one benefit period. Your copayment for days 61-90 is $371 for each benefit period in 2021.
- After youve spent more than 90 days in the hospital during a single benefit period, youll generally have to pay a coinsurance amount of $742 per day in 2021. You pay this coinsurance until youve used up your lifetime reserve days . After that, you typically pay all health-care costs.
*A benefit period begins when youre admitted as an inpatient. It ends when you havent received inpatient care for 60 days in a row. You could have more than one benefit period within a year, and you generally pay a deductible for each benefit period.
If youre not a hospital inpatient:
For example, if the Medicare-approved amount for a doctor visit is $85, your coinsurance would be around $17, if youve already paid your Part B deductible.
Be aware that Original Medicare has no annual out-of-pocket maximum spending limit. If you meet your Medicare Part A and/or Part B deductibles, you still generally pay a coinsurance or copayment amount and theres no limit to what you might pay in a year.