Does Medicare Cover Home Health Aides?
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.
How does Medicare cover home health care?
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:
- Part-time or intermittent home health aide
- Part-time or intermittent skilled nursing care
- Physical and/or occupational therapy
- Speech language pathology services
- Medical social services
- Certain durable medical equipment and supplies, in some cases
Who may be eligible for home health aides under Medicare?
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:
- Intermittent skilled nursing care (besides drawing blood)
- Physical therapy, speech-language pathology, or continued occupational therapy services. You may want to check with Medicare (or your Medicare Advantage plan, if you have one) about the specific rules about these types of therapy and how much is covered.
What home health services are not covered by Medicare?
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:
- Homemaker services, such as shopping or laundry, aren’t generally covered under Medicare.
- Medicare doesn’t cover meals delivered to your house.
- If you need round-the-clock care at home, Medicare generally doesn’t cover it.
How much do home health services cost?
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.
Getting home health services in certain states
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.