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Sometimes you may find you need help at home to do everyday tasks because of a health problem. Home health care might involve helping you get dressed, preparing meals, or bathing – or more medically oriented care like changing dressings on a wound.
Generally, Medicare coverage of home health aides is limited and temporary. We’ll get into more detail below.
Medicare Part A (hospital insurance) and/or Part B (medical insurance) may cover home health aides if your doctor orders this care for you and determines that it’s medically necessary. Usually Medicare won’t cover a full-time, long-term home health aide. The care must be part-time and provided from time to time – not constant.
Here’s the kind of home health services Medicare may cover:
Medicare has coverage rules about home health aides. Here are some of them (this may not be a complete list):
You must be under a doctor’s care with a care plan that your doctor reviews regularly.
You must be homebound, as certified by your doctor. Medicare considers homebound to mean you can’t leave your home without help, or your health condition generally requires you to stay at home. You can still qualify as “homebound if you go to religious services, doctor appointments, or adult day care.
Your doctor must certify that you need at least one of these:
Medicare doesn’t typically cover home health aide services if the only care you need is “custodial.” Custodial care doesn’t require medical skills. It’s care such as dressing or bathing assistance, eating, or using the bathroom. These are just a few examples of custodial care. Also, be aware that:
If you’re eligible for Medicare coverage of your home health care, you generally don’t have to pay for it. If you need durable medical equipment, you’ll typically pay 20% of the Medicare-approved amount.
Be aware, however, that your doctor might request more home health care services for you than Medicare will approve. If you have questions, ask your doctor, or call Medicare at the number listed at the bottom of this page.
If you live in Massachusetts, Michigan, Florida, Illinois, or Texas, a Medicare demonstration program might apply. Under the program, you (or your home health care provider) can request a pre-claim review. This review can tell you early on whether Medicare is likely to cover your home health services. If you’re a resident of one of these states, you might want to request a pre-claim review as soon as your doctor orders home health care for you, so you’ll know whether you’ll have to pay anything.
Do you have questions about your Medicare coverage options? You can compare Medicare plan options by entering your ZIP code and clicking the button on this page.
eHealth's Medicare website is operated by eHealthInsurance Services, Inc., a licensed health insurance agency doing business as eHealth. The purpose of this site is the solicitation of insurance. Contact may be made by an insurance agent/producer or insurance company. eHealth and Medicare supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. We offer plans from a number of insurance companies.