Most patients would prefer to receive care for an illness or injury in the comfort of their own home. Fortunately, home health care can be as effective as inpatient care in a hospital or skilled nursing facility. Studies on healing at home have shown improved outcomes and quicker recoveries for patients. Home health care can be less costly than a long hospital stay and Medicare can help cover the costs.

If your physician orders reasonable and medically necessary treatment of an illness or injury, Medicare will help pay for home health services as long as you meet certain criteria. To be eligible for home health services, your condition must be expected to improve in a generally predictable period of time. You may also qualify if you need a skilled therapist to safely and effectively create a maintenance program and to perform maintenance therapy for your condition. A registered nurse or licensed practical nurse may administer your home care which may include giving IV drugs, changing wound dressings, tube feedings, teaching about diabetes care, or certain injections.

The home health aides must work for a Medicare-approved home health agency and your doctor must certify that you are homebound. These agencies agree to be paid the Medicare-approved amount and to be paid directly by Medicare. The home health agency will be responsible for all of your medical, nursing, and rehabilitative care and will communicate your needs to the managing physician. Your condition will be monitored and assessed regularly and will create discharge plans when appropriate.

What types of services can you receive in home health care?

  • Intermittent skilled nursing care (fewer than 7 days/week, less than 8 hours/day, up to 21 days)
  • Physical therapy
  • Speech and language pathology therapy
  • Occupational therapy
  • Medical social services

The Cost of Home Health Care

If you have Original Medicare, you will not pay anything for home health visits, but if you require medical equipment, you will pay 20% of the Medicare approved amount for the rental or purchase of the durable medical equipment (DME). The Medicare Part B deductible will apply. Many Medicare recipients choose to purchase supplemental insurance to help cover the out-of-pocket costs from Part A and Part B. If you have enrolled in a Medigap plan, it may help pay for deductibles and coinsurance associated with home health care. If you choose to get your Medicare benefits through a Medicare Advantage (MA) plan, you will have at least the same coverage as Original Medicare, but many MA plans offer additional benefits.

If you need more than part-time or intermittent care, you will not be eligible for home health care benefits. Medicare does not cover custodial care. Custodial care includes non-medical services and activities of daily living, such as bathing, dressing, and household chores like cooking and laundry.

Related articles:

What is Medigap?

What is Medicare Parts A & B