If you qualify, Original Medicare pays for covered home health services, such as part-time skilled nursing and therapy at home, and you pay nothing for them. You may still owe 20% of the Medicare-approved amount, after the Part B deductible, for medical equipment like a walker or wheelchair. To qualify, you generally must be homebound, under a doctor's care, and getting services from a Medicare-certified home health agency.
What does Medicare home health cover?
Medicare.gov lists services that can be covered when they're reasonable and necessary:
- Part-time or intermittent skilled nursing care.
- Physical therapy, occupational therapy, and speech-language pathology services.
- Part-time or intermittent home health aide services, when you're also getting skilled care.
- Medical social services.
- Medical supplies for use at home.
Medicare.gov says "part-time or intermittent" usually means you may be able to get skilled nursing and home health aide services combined for up to 8 hours a day, with a maximum of 28 hours a week. You won't qualify if you need more than part-time or intermittent skilled care.
What doesn't Medicare home health cover?
Common things Medicare doesn't pay for under home health include:
- 24-hour care at home.
- Meals delivered to your home.
- Homemaker services like shopping, cleaning, and laundry, when that's the only care you need.
- Personal care like bathing, dressing, or using the bathroom, when that's the only care you need.
If an agency provides services that aren't covered, you may get a bill for them. Ask the agency to tell you in writing before it gives you services Medicare may not pay for.
Who qualifies for Medicare home health?
According to Medicare.gov, you must meet these conditions:
- You're under the care of a doctor or other provider, and your care follows a plan of care they review regularly. Medicare.gov says the plan should be reviewed at least once every 60 days.
- Your provider certifies that you need skilled nursing care on an intermittent basis or therapy.
- Your provider certifies that you're homebound.
- You get services from a Medicare-certified home health agency.
Homebound doesn't mean you can never leave the house. Medicare.gov describes it as being normally unable to leave home, where leaving takes a lot of effort. People who are homebound can still go to medical appointments, religious services, or adult day care.
Why did I get a bill for home health care?
If covered services cost you nothing, a bill is worth checking. Common reasons include:
- Medical equipment. Durable medical equipment like a hospital bed or walker falls under Part B. You pay 20% after the Part B deductible.
- Services Medicare decided weren't covered. For example, if you stopped being homebound, or the care was only personal care.
- The agency isn't Medicare-certified. Check the agency on Medicare's Care Compare tool.
- A Medicare Advantage plan. Plans cover home health too, but they may have their own rules, networks, and prior authorization. Costs may differ.
- A billing mistake. For example, a copay charged for a service that should cost $0.