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Older adults may find themselves wondering whether Medicare will cover costs associated with home health care should the need arise. Home care runs the gamut from physical therapy to end-of-life hospice care, and regardless of the type, home health care can be expensive.
Home health services cost people in the U.S. more than $123 billion in 2020, according to the National Health Expenditure Accounts (NHEA)[1]. Given the rising cost of health care, it’s important to understand how to use Medicare benefits to pay for the care you or your loved one needs at home.
Home health care is care that occurs within your home and includes nursing services like infusions, medication management, post-surgical procedures and physical therapy. It’s not the same thing as home care, which typically consists of supportive care and assistance with activities of daily living (ADLs).
Home health care is primarily intended to treat an acute illness or injury. The goal is for the patient’s health to improve enough that they regain independence and, if that’s not possible, to manage symptoms to help them become as self-sufficient as they can, according to Medicare.gov.
Medicare Part A and Part B cover home health care if the services needed are considered reasonable and necessary for the person’s specific illness or injury, says Ari Parker, co-founder and head advisor at Chapter, an independent Medicare advisor organization. Furthermore, you must be under the care of a doctor who declares you homebound to qualify for home health care under Medicare.
“Medicare covers skilled nursing care, physical therapy, occupational therapy and speech-language pathology services. In addition, Medicare covers home health aide services and Medicare social services, which is when a doctor may recommend counseling to help with social and emotional concerns that could hinder the recovery process,” adds Parker.
While Medicare covers part-time or intermittent skilled nursing, physical and occupational therapy and other qualified services in the home, it becomes less beneficial when the level of home health care shifts toward custodial or constant care.
“Medicare will not cover 24-hour-a-day care, delivery of meals or home care services, such as cleaning, laundry or support with activities of daily living (ADLs), such as bathing, toileting or dressing,” says Chris Orestis, Certified Senior Advisor and president of Retirement Genius, a website dedicated to helping seniors navigate retirement.
If you’re enrolled in Original Medicare, you will use both Part A and Part B to cover limited home health services, says Parker.
Some Medicare Advantage plans also offer additional benefits, such as caregiver support services or home modifications. However, the benefits offered for home health care vary widely from plan to plan, so it’s important to understand the coverage offered before you sign up for a Medicare Advantage plan, adds Parker.
Before receiving home health care, you must meet Medicare’s requirements for it to be medically necessary, says Lindsay Malzone, Medicare expert for Medigap.com. According to Malzone, the following conditions must be met to qualify for Medicare-covered home health care:
According to Orestis, Medicare Part A (hospital insurance) and/or Medicare Part B (medical insurance) cover the following eligible home health services:
The cost of home health care can be staggering, especially if you’re seeking full-time care. According to the latest Genworth Cost of Care survey, the price of having a home health aide provide care on a full-time basis is $5,148 per month[2]. For less intensive services, like the ones listed above, you might pay nothing out of pocket—as long as the services are covered by Medicare and prescribed by a doctor. It’s important to note that the average hourly rate for home health care varies by state, which can help you determine potential home health care costs based on where you live.
While it’s untrue that Medicare doesn’t pay for home health care, there are many services that aren’t covered. Your individual experience as to how helpful Medicare is when it comes to covering these types of expenses will vary based on the type of care you need and how long you need it, among other factors. For the most part, basic home health care services aimed at helping you get back on your feet and live a functional life are typically covered by most Medicare plans. If you need home health care services, it’s best to check with your plan administrator if you have specific questions about your coverage.
Footnotes
References
Christin Perry, Contributor
Does Medicare Cover Home Health Care In 2024?
Home health services cost people in the U.S. more than $123 billion in 2020, according to the National Health Expenditure Accounts (NHEA)[1]. Given the rising cost of health care, it’s important to understand how to use Medicare benefits to pay for the care you or your loved one needs at home.
What Is Home Health Care?
Home health care is care that occurs within your home and includes nursing services like infusions, medication management, post-surgical procedures and physical therapy. It’s not the same thing as home care, which typically consists of supportive care and assistance with activities of daily living (ADLs).
Home health care is primarily intended to treat an acute illness or injury. The goal is for the patient’s health to improve enough that they regain independence and, if that’s not possible, to manage symptoms to help them become as self-sufficient as they can, according to Medicare.gov.
Does Medicare Cover Home Health Care?
Medicare Part A and Part B cover home health care if the services needed are considered reasonable and necessary for the person’s specific illness or injury, says Ari Parker, co-founder and head advisor at Chapter, an independent Medicare advisor organization. Furthermore, you must be under the care of a doctor who declares you homebound to qualify for home health care under Medicare.
“Medicare covers skilled nursing care, physical therapy, occupational therapy and speech-language pathology services. In addition, Medicare covers home health aide services and Medicare social services, which is when a doctor may recommend counseling to help with social and emotional concerns that could hinder the recovery process,” adds Parker.
While Medicare covers part-time or intermittent skilled nursing, physical and occupational therapy and other qualified services in the home, it becomes less beneficial when the level of home health care shifts toward custodial or constant care.
“Medicare will not cover 24-hour-a-day care, delivery of meals or home care services, such as cleaning, laundry or support with activities of daily living (ADLs), such as bathing, toileting or dressing,” says Chris Orestis, Certified Senior Advisor and president of Retirement Genius, a website dedicated to helping seniors navigate retirement.
Which Medicare Parts and Plans Cover Home Health Care?
If you’re enrolled in Original Medicare, you will use both Part A and Part B to cover limited home health services, says Parker.
Some Medicare Advantage plans also offer additional benefits, such as caregiver support services or home modifications. However, the benefits offered for home health care vary widely from plan to plan, so it’s important to understand the coverage offered before you sign up for a Medicare Advantage plan, adds Parker.
What Are the Medicare Eligibility Criteria for Home Health Care?
Before receiving home health care, you must meet Medicare’s requirements for it to be medically necessary, says Lindsay Malzone, Medicare expert for Medigap.com. According to Malzone, the following conditions must be met to qualify for Medicare-covered home health care:
- A doctor must certify that the patient is homebound.
- Home health care must be deemed medically necessary.
- A care plan must be established and regularly reviewed by a doctor.
- The patient must use a Medicare-approved home health agency.
Which Home Health Services Are Covered Under Medicare?
According to Orestis, Medicare Part A (hospital insurance) and/or Medicare Part B (medical insurance) cover the following eligible home health services:
- Physical therapy
- Occupational therapy
- Speech pathology
- Medical social services
- Intermittent home health aides
- Injectable osteoporosis drugs for women
- Durable medical equipment (DME) and medical supplies
What Is the Cost of Home Health Care?
The cost of home health care can be staggering, especially if you’re seeking full-time care. According to the latest Genworth Cost of Care survey, the price of having a home health aide provide care on a full-time basis is $5,148 per month[2]. For less intensive services, like the ones listed above, you might pay nothing out of pocket—as long as the services are covered by Medicare and prescribed by a doctor. It’s important to note that the average hourly rate for home health care varies by state, which can help you determine potential home health care costs based on where you live.
While it’s untrue that Medicare doesn’t pay for home health care, there are many services that aren’t covered. Your individual experience as to how helpful Medicare is when it comes to covering these types of expenses will vary based on the type of care you need and how long you need it, among other factors. For the most part, basic home health care services aimed at helping you get back on your feet and live a functional life are typically covered by most Medicare plans. If you need home health care services, it’s best to check with your plan administrator if you have specific questions about your coverage.
Footnotes
- National Health Expenditure Data (Historical). Centers for Medicare and Medicaid Services. Accessed 9/7/2022.
- Cost of Care Survey. Genworth.com. Accessed 8/31/2022.
References
- Home Health Care 101: Frequently Asked Questions. Keystone Health.
- Accessed 8/29/2022.Home Health Services. Medicare.gov. Accessed 8/29/2022.
