Does Medicare Cover Home Health Care?

Many times the best place to provide care for someone isn’t in a nursing home, hospital or other facility. It’s in the home. And when a family needs help caring for a loved one, that’s when home health care can help.

Home health care may either be long-term or short-term, depending on the person’s medical condition and the type of care that he/she needs.

Home health care is very common these days and many people have the question, “does Medicare cover home health care?” In this article, we answer that question in clear, plain English. You will also find the average costs of home health care and other helpful info.

Does Medicare Cover Home Health Care?

The short answer is yes; Medicare will cover the cost of home health care. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your home health care. Below we look at what these are so you know what to expect.

Original Medicare

Original Medicare (Medicare Part A and Part B) provides coverage for home health care. However, not all types of home health care are covered by Medicare. Depending on the situation, coverage for home health care may either fall under Medicare Part A or B if you have a condition that requires home health care.

However, there are some conditions that have to be met before Medicare Part A and Part B will provide coverage for your home health care. These conditions include:

You cannot leave your home unless you need to go on a short outing such as visiting your doctor. (Medicare will still cover your home health care even if you go to an adult daycare)
Your healthcare provider ordered that you need home health care. He/she must write an outline for the kind of care you need
Your healthcare provider must determine that you are homebound
You require skilled nursing care. But skilled nursing care can only last for 8 hours per day and 28 hours per week for up to three weeks
Your healthcare provider believes that you will recover from your condition in a reasonable amount of time
You need physical, occupational, and/or speech therapy to maintain or improve your condition or prevent it from worsening
Your home-health agency is Medicare-approved

Medicare Part A also provides coverage for home-based hospice care as long as your hospice provider is enrolled in Medicare and accepts Medicare coverage. Hospice care is the type of care someone receives if they have a terminal illness.

Part C Coverage for Home Health Care

Medicare Advantage plans (Medicare Part C) also provide coverage for home health care. Part C plans are required to cover everything Original Medicare covers. These plans offer additional benefits as well. The specifics of what they will cover and what the costs for coverage are will vary from plan to plan.

However, neither Original Medicare and Medicare Advantage plans provide coverage for custodial care.

How Much Does Home Health Care Cost?

Having a home caregiver can cost over $20 per hour. While it varies by state, home health care can cost an average of $4,000 per month.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.