Does Medicare Cover Home Care and Home Health Care?

Medicare covers home health care services that are considered both reasonable and necessary for the treatment of an illness or injury. Medicare benefits for home health care coverage include the following:^[01]

• Skilled nursing care. Under Medicare, in-home skilled nursing services are covered if they’re part-time or intermittent, which is classified as fewer than eight hours per day and fewer than 28 hours per week (35 hours per week may be permitted in certain situations). Services include certain injections, tube feeding, changing wound dressings, and receiving IV drugs. Nursing homes are one of the most common facilities that offer skilled nursing care, although other senior care facilities may also offer some short-term skilled nursing services.
• Home health aide services. Medicare will cover part-time or intermittent home health aide services only if they’re performed in conjunction with skilled nursing, physical therapy, speech-language pathology, or occupational therapy.
• Occupational therapy, physical therapy, and speech pathology. Therapy services performed as a part of Medicare-covered home health care must be necessary to restore or improve functions affected by an injury or illness. The amount of therapy and how long the senior receives these services must be considered reasonable.
• Medical social services. If emotional or social concerns may delay a senior’s recovery or interfere with treatment, Medicare may cover medical social services such as counseling, as long as they’re ordered by a doctor — and they’re only covered if a senior is also receiving skilled nursing.
• Medical supplies. Medicare will cover medical supplies like wound dressings if they’re ordered by a doctor as part of home health care. Additionally, Medicare will typically pay 80% for durable medical equipment such as walkers, wheelchairs, oxygen equipment, or hospital beds.

Home health care is covered by Medicare Part A (hospital insurance) and Part B (medical insurance).^[01] Additionally, Medicare Part D can help pay for prescription drugs a senior may need. Home health care services must be provided by a Medicare-certified home health agency, not a family member.

To qualify for home health care, Medicare beneficiaries must meet the following eligibility requirements:^[01]

• They’re getting care from a doctor. The services they’re receiving must be part of a care plan that’s reviewed regularly by a physician. Their doctor or a medical professional working with their doctor must document that they’ve had appointments within certain time frames, and those appointments must be related to the need for home health care.
• They require certain health-related services. Medicare home health care services include part-time or intermittent skilled nursing, physical therapy, speech-language pathology services, or occupational therapy.
• They’re certified by a doctor as homebound. This means that leaving their house is difficult without help, requires a major effort, or isn’t recommended. However, if they’re considered homebound, they may still leave home for medical treatment or brief and infrequent trips for nonmedical purposes like haircuts or birthday parties.

How long will Medicare pay for home health?

Medicare will only pay for home health care if a senior requires skilled nursing for under eight hours a day, fewer than seven days a week, and no longer than three weeks. The coverage may be extended longer than three weeks in if a doctor can foresee when the senior’s need for skilled nursing will end.^[01]

Does Medicare cover in-home care for people with dementia?

Medicare won’t pay for home care for people who only have a diagnosis of Alzheimer’s disease or another type of dementia. However, Medicare will cover home health care related to other health conditions, such as rehabilitation after surgery for individuals living with dementia.

Medicare will also pay for services often needed by people with dementia, including home safety evaluations, cognitive assessments, care planning, hospital stays, and prescriptions if they have Part D coverage.^[02]

Some in-home care services aren’t included in Medicare plans. However, home health care agencies are required to provide an Advance Beneficiary Notice of Non-coverage (ABN) before providing services or supplies that Medicare likely won’t cover.

Common reasons that a home health agency might provide a senior with an ABN include the following:^[01]

• The care isn’t reasonable or necessary.
• The only care a senior needs is considered nonskilled (e.g., personal care).
• They’re not classified as homebound.
• They require more than intermittent skilled care.

The directions for getting an official decision should be included in the ABN, and seniors have a right to appeal if Medicare won’t pay.

Medicare won’t pay for home care if nonmedical assistance is the only type of service that a senior needs. However, Medicare home care benefits may cover personal care that’s provided in conjunction with eligible home health services, such as transitional home care services.

Understand that home health care and home care aren’t the same. While home health care provides medical services intended to help someone recover from an injury or illness, home care offers ongoing nonmedical assistance to people who can no longer live independently. For example, home care services might include housekeeping, transportation, meal preparation, and personal care (e.g., bathing, using the bathroom, and grooming).

If a family member needs help finding home care, A Place for Mom’s Senior Living Advisors will go over options in your loved one’s area that best fit their needs. Additionally, a Senior Living Advisor can provide information about other senior living options such as independent living, assisted living, and memory care — all at no cost to seniors and their families.

A Place for Mom doesn’t refer individuals to home health care, but seniors and their families can talk to a doctor, hospital discharge planner, or a representative at their local Area Agency on Aging. To compare home health care options, visit the Medicare website.