Medicare offers coverage for personal home care, but there are certain conditions that you need to meet to be covered for those services.
Medicare Home Health Care Coverage
Medicare will cover the following home health services:
- Part-Time Or “Intermittent” Skilled Nursing Care
- Part-time or intermittent home health aide services
- Injectible osteoporosis drugs for women
- Speech-language pathology services
- Medical social services
- Physical therapy
- Occupational therapy
Home Health Services Not Covered by Medicare
Medicare will not cover:
- Meals delivered to your home
- Homemaker services (shopping, cleaning, etc.), when this is the only care you need
- 24-hour-a-day care at home
- Custodial or personal care (bathing, dressing, etc.), when this is the only care you need
Eligibility for Home Health Care Coverage
Medicare beneficiaries who receive home health care will only be covered for those services by Medicare if they meet a few conditions. They must be under a doctor’s care and be receiving services under a plan of care made and reviewed by that doctor. You must either need intermediate skilled nursing care or need physical therapy, occupational therapy, or speech-language pathology services (these services must be specific, safe, and effective for your condition). You must also be homebound, which must be certified by a doctor.
Costs of Home Health Care
Your costs under Medicare for home health services are $0. You pay 20% of the Medicare-approved amount for covered services, as is typical for all Part B covered services.
If the home health agency is providing services that Medicare will not cover, they must inform you of those costs verbally and in writing. You should receive an Advance Beneficiary Notice of those costs for those services not covered by Medicare, just as you would for ambulance services.
Your doctor may recommend services that Medicare does not cover. Ensure that you understand their reasoning and what you will need to pay for those services, so you are not surprised later.
Nurse practitioners, clinical nurse specialists, and physician assistants can provide home health services without physician certification during the pandemic.
Midwest Medigap Services
Let us work with you to find the Medicare coverage you need. If you or a loved one needs personal home care, don’t hesitate to reach out. Contact us today at 800-805-6834 to learn more about Medicare and the coverage you can expect.
