Some seniors become homebound due to medical conditions like dementia. When that happens, it is important to ensure they receive the care they need. That is when a caregiver who provides health care in-home can be useful.

So a common question many people have is, “does Medicare cover home health?” 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?

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.

Coverage for the expenses for your home health aide is provided by Medicare Part A and Part B. Medicare Part A and Part B provide coverage for the services of your home health aide if you are injured or ill and you require their assistance.

But for Medicare Part A and Part B to provide coverage for your home health care, these conditions have to be followed:  

  • Due to your illness or injury, you cannot leave your home unless the reason for leaving is for a short outing such as visiting the doctor. Medicare still provides coverage for home health care if you visit adult daycare
  • Your healthcare provider finds it necessary and prescribes home health care and writes an outline of the kind of care you need
  • Your healthcare provider must certify that you are homebound
  • You require skilled nursing care. However, your skilled nursing care is only limited to 8 hours per day and 28 hours per week for up to three weeks
  • Your healthcare provider finds it likely that your condition will improve in a reasonable amount of time
  • You need assistance from a skilled physical, occupational, or speech therapist to design a program that can help you improve or maintain your current state, or prevent it from getting worse
  • Your home-health agency is Medicare-approved

Some of the services that you may receive in in-home caregiver care include:

  • Physical therapy
  • Occupational therapy
  • Speech therapy
  • Nursing care
  • Home-health aides

However, Medicare Part A and Part B do not provide coverage for custodial care. Medicare Part A and Part B will only cover custodial care if you require it for a short amount of time while you are recovering from an injury or illness.

Part C and Part D Coverage for Home Health

Medicare Advantage plans (Medicare Part C) also provide coverage for home health care. They cover everything Original Medicare covers, as well as usually offer some additional benefits. However, exactly what it covers and what your out-of-pocket costs are will vary depending on the specifics of your plan. 

Medicare Part D is a prescription drug plan and does not cover home health aides. However, they provide coverage for prescription drugs that you need during your home healthcare period. 

How Much Does Home Caregiver Care Cost?

Having home caregiver care may cost $20 or more per hour. The average monthly cost of a caregiver is around $4,000. The costs will vary from state to state.

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.

Additional Info on Medicare Coverage

This article is part of our series on “What does Medicare cover?”

Also, you can check out other articles in this series including: Does Medicare cover Dexilant?

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