Find Medigap Plans That Help Cover Your Home Health Care
If you home health care that is covered by Medicare, you may likely face out-of-pocket Medicare costs such as deductibles, coinsurance and copayments.
A Medicare Supplement Insurance plan can help cover some of these costs.
For example, each of the 10 standardized Medigap plans that are available in most states provide at least partial coverage for the Medicare Part B coinsurance or copayments you might face when you receive covered home health care.
A licensed agent can help you decide on a Medicare option that works for you. Call today to speak with a licensed agent and compare the Medigap plans that are available where you live.
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
Will Medicare Cover Skilled Nursing Care
Medicare will pay for whats considered intermittent nursing services, meaning that care is provided either fewer than seven days a week, or daily for less than eight hours a day, for up to 21 days. Sometimes, Medicare will extend this window if a doctor can provide a precise estimate on when that care will end.
Skilled nursing services are generally required to treat an illness or assist in the recovery of an injury. As the name implies, those who provide this care are licensed to administer medical treatment such as injections, catheter changes, wound dressings, and tube feedings.
The maximum amount of weekly care Medicare will pay for is usually 28 hours, though in some circumstances, it will pay for up to 35. But it wont cover 24-hour-a-day care.
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How Many Days Will Medicare Pay For Home Health Care
Your Medicare-satisfied home health caregiver is paid by Medicare, a payment that covers a beneficiary for 30 days. Payment for every 30 days is based on the condition and care needs of the beneficiary. Skilled nursing care is only covered for less than seven days a week or less than 8 per day across a 21 day span.
Does Medicare Cover Elective Procedures
Services that are not considered medically necessary are generally not covered by Medicare Part A or Part B. For example, breast augmentation for cosmetic reasons isnt covered by Medicare, but reconstructive surgery after a mastectomy is covered.11
Medicare wont cover Lasik surgery just to avoid the need for glasses. But treatment for chronic eye conditions like cataracts or glaucoma may be covered if your doctor considers it to be medically necessary.12
Always err on the side of caution! Confirm your coverage before you commit to a procedure youre unsure about.
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Do Medicare Advantage Plans Cover In
Medicare Advantage plans provide your Medicare Part A and Part B coverage. Instead of getting Part A and Part B through the federal government directly, you get them through a private insurance company that contracts with Medicare.
So, your in-home health care benefits will be at least the same as what Medicare Part A and Part B offer . Medicare Advantage plans may have annual deductibles, and may charge coinsurance or copayments for these services. Medicare Advantage plans have out-of-pocket maximum amounts, which protect you from unlimited health-care spending.
Youll need to keep paying your Medicare Part B premium when you have a Medicare Advantage plan.
Want to learn more about Medicare Advantage plans? Its easy to take a look at the plans in your area and see what benefits they offer besides Medicare Part A and Part B coverage. Just type your zip code in the box on this page, and you can compare Medicare Advantage plans at your convenience.
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How Do Medigap Plans Cover Home Health Care
Medigap plans are designed to cover the 20% coinsurance left over after Medicare pays 80% of approved charges. But because Medicare covers home health care in full, there is no coinsurance to file with a Medigap plan.
However, if you need durable medical equipment such as a wheelchair or walker while receiving home care, those charges are billed separately and subject to the Medicare Part B deductible and coinsurance. If you have Medigap coverage, you pay the deductible and submit the 20% coinsurance charges to your Medigap plan for payment. Most Medigap policies cover your cost in full, but benefits vary by plan.
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What Is Home Health Care
Like the name suggests, home health care involves a wide range of health and social services that are usually performed at a patients own home to treat illness, injuries, or other medical conditions.
Depending on the patients situation and medical care needs, home health care services can range from nursing care, laboratory functions, and social-work services. Some of the standard home health care services include:
- Doctor consultation
What Home Health Aides Are Not Covered By Medicare
Home health aides are also called nurse aides or certified nurse aides who have completed federal- and state-mandated training and maintain a license or certification through their state. Medicare will cover licensed or certified aides when their services are part of a plan of care provided by a Medicare-approved home health agency.
Medicare will not cover home health aides who do not meet the above requirements or home health aide services that arent reasonable and necessary. Additionally, Medicare wont cover home health aide services that exceed the daily or weekly limit outlined on the plan of care.
Sometimes, people refer to personal care providers, personal companions, or homemakers as home health aides. Even though their services are valuable and necessary for many seniors, Medicare will not pay for them.
Homemaker services such as shopping, cleaning, and laundry are not covered, even if the individual providing them is a licensed or certified home health aide. Medicare also wont cover custodial or personal care like bathing, grooming, and assistance using the bathroom if this is the only care you need.
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What Home Care Services Does Medicare Cover
The primary objective of Medicares home care program is to provide seniors with short-term skilled services in the comfort of their own homes as an alternative to recovering in a hospital or skilled nursing facility.
Skilled nursing services are those that must be provided by a qualified health professional, such as a Registered Nurse or a Licensed Practical Nurse .
Examples of these services include:
- Monitoring of a patients vital signs and overall health
- Wound care for a pressure ulcer or surgical incision
- Administration of intravenous drugs or nutrition therapy
- Catheter changes
- Patient and caregiver education
Skilled therapy services are those that must be provided by or under the supervision of a licensed physical therapist, occupational therapist or speech-language therapist.
- Physical therapy exercises typically focus on improving and restoring strength, balance and range of motion for optimal physical function.
- Occupational therapy assists in regaining the ability to independently engage in activities of daily living and adapting these tasks or the surrounding environment to improve functionality and accessibility.
- Speech-language therapy helps patients regain the ability to speak and communicate as well as overcome swallowing difficulties .
Medicare Covers Home Care Services Under Medicare Parts A And B
Both Medicare Part A and Part B cover a range of home care services, but its important to understand the differences of what each plan covers.
For example:
Medicare Part A Covered Home Care ServicesUnder Part A , you can be covered for home care services if you had to spend a minimum of 3 consecutive days at the hospital as an inpatient, or had to have a skilled nursing facility stay of the same duration. In this case, you may still require skilled nursing care and therapy at home. Medicare Part A covers the first 100 days of home health care services provided that you meet the eligibility requirements of being essentially homebound and needing skilled care to recover from the injury, illness or condition that precipitated the hospital stay. Its also important that you start receiving these home care services within a 14-day time frame from your stay at the hospital or SNF.
Medicare Part B Covered Home Care ServicesIf you require home health services beyond 100 days, Medicare Part B can cover these services.
Your doctor should then sign a home health certification that designates which specific home health care services you need, why you need them, for how long, and what the desired outcome should be. Your home healthcare agency can then create a plan of care that meets those requirements outlined by your doctor.
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What Are The Benefits Of Home Health Care
The primary benefit of home health care for the elderly is that it can be delivered directly to the patient’s residence, whether it be a private home, adult foster home, assisted living or residential care facility, memory care facility, or long-term nursing home. By delivering care directly to the patient, expensive hospital bills can be avoided.
Family members are encouraged to be active participants in the planning process to help set and meet goals, working with home health care professionals for the benefit of the patient.
Additional benefits of home health care for seniors include:
- Faster recuperation and recovery from illness or injury
- Improved independence
Pros of Home Health Care
- Care is delivered directly to the patient’s residence
- Medical services are provided by skilled professionals
- Home health care staff follow the physician-prescribed plan
- Patients regain independence and self-sufficiency at home
- Care is typically less expensive than hospitalization or a long-term nursing home
Cons of Home Health Care
- Home care services like cooking and cleaning may not be included
- Patients must meet the “homebound” requirements to qualify for Medicare
- May not be adequate for patients who require 24-hour monitoring
- Can be expensive if not covered by insurance or Medicare
- Number of home health care providers may be limited depending on location
How Long You Can Receive Home Health Services
For general home health services, youre covered for as long as youre eligible and your doctor recommends receiving those services. But skilled nursing care and home health aide services are covered only on an intermittent basis, which is defined as less than eight hours per day and 28 or fewer hours each week, once youre receiving care. If you need services beyond intermittent skilled nursing care or home health aide services, they will not be covered by Medicare.
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Services Medicare Doesnt Cover
Though Medicare can be a huge help in covering home health care, it doesnt cover everything. Here are some of the services that arent included as part of these benefits:
- Around-the-clock care
- Personal care services if you dont also require skilled medical care or therapy
- Homemaking services if you dont also require skilled medical care or therapy.
Before your care starts, your Medicare-certified home health agency should present you with a breakdown of the charges and what Medicare will pay. This notice should also include how much youll be required to pay out of pocket.
If the agency wants to provide care that isnt covered, its required to give you an Advance Beneficiary Notice . This notice explains the treatment plan, directions for getting Medicare to decide on coverage, and instructions for filing an appeal.
Does Medicare Pay For Home Health Care
There is an important distinction between medically necessary home health care and personal care services provided by an unskilled caregiver. Understanding the difference between these two levels of care is key to determining who is eligible for Medicare-covered in-home services. For more information on this topic, read The Difference Between Home Health Care and Non-Medical Home Care Services.
Only home health care services prescribed by a doctor and provided by skilled caregivers are covered by Medicare, but patients must meet specific eligibility requirements.
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How Much Does Medicare Pay For In
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 for any services and supplies that Medicare does not cover.
Does Medicare Cover Home Health
Medicare does help cover some
To be eligible, you must be under the care of a doctor and treated under a plan of care that is monitored and reviewed by your doctor. Also, your doctor will need to certify that you need certain eligible in-home services.
Medicare will not pay for 24-hour in-home care or meals delivered to you at home. It also doesnt cover help for whats called activities of daily living, like bathing, getting dressed, using the toilet, eating or moving from place to place within your home.9
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What Is A Home Health Aide
A home health aide is a professional who provides assistance to patients with special needs, including those who are disabled, chronically ill, or cognitively impaired. They may also provide services for seniors who require assistance in the home.
A home health aide may provide services including checking vital signs, assisting with personal hygiene, administering medication, and employing other elements of a physician-prescribed plan of care.
Home Health Aide vs. Personal Care Aide
The duties of a home health aide and a personal care aide overlap at times, but the key difference is that home health aides typically work for agencies instead of being directly employed by their clients. Home health aides play an important role in the continuity of care, coordinating among caregivers and medical professionals, and tracking the condition and progress of their clients.
While home health aides and personal care aides provide services to the same type of patient, a personal care aide’s duties are typically limited to non-medical services. This may include dressing, bathing, cooking, cleaning, running errands, doing laundry, and providing companionship for their clients.
When Might Medicare Cover In
In general, Medicare doesnt cover long-term home health care. Heres how Medicare coverage of in-home health care typically works.
In most cases, even when Medicare covers in-home health care, its for part-time care, and for a limited time. Some of the requirements may include:
- You must be under the care of a doctor, who must have a plan of care for you that she or he regularly reviews.
- The in-home health agency must be Medicare-approved.
- Your doctor must certify that youre unable to leave your home without some difficulty for example, you might need transportation and/or help from a cane, a walker, a wheelchair, and/or someone to help you. In other words, youre homebound.
- Your doctor has to certify that you need certain kinds of in-home care, such as:
- Skilled nursing services when you dont need constant care. That is, you need these services intermittently.
- Continued occupational therapy*
- Speech language pathology*
This may not be a complete list.
*Medicare has certain rules about covering this type of service. If your doctor orders it for you, you may want to contact your Medicare Advantage plan, or Medicare, to see if itll be covered. Contact information for Medicare is at the bottom of this page.
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What You Pay For Home Health Services
All eligible Medicare recipients pay the following for home health services:6
- $0 for home health services
- 20% of the Medicare-approved amount for like a walker, wheelchair or hospital bed
Before home health care begins, your home health agency should explain your bill. This includes what Medicare will help cover, what Medicare wont cover and how much youll owe . The details of what isnt covered by Medicare must be given to you in an before you receive any uncovered items or services.7
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How Do I Choose A Home Health Agency
To organize your search, build a home health agency checklist to help narrow your options. You may want to ask, for example, if the agency accepts Medicare payment or offers the specific services you need. You can use the checklist on the Medicare.gov website or create your own based on your personal health needs and budget.
Once you have your checklist ready, you can review home health agencies via the compare page on Medicare.gov. Click the home health services button to learn about providers near you, including quality ratings and contact information.
