Does medicare part a cover home health

If you’re around the age of 65, there’s a nearly 70% chance that later in life you’ll need some type of long-term care while you recover at home, according to the U.S. Department of Health & Human Services. That might include help with such things as getting dressed, preparing meals, and bathing.

The good news is that Original Medicare, both Part A and Part B, as well as Medicare Advantage (Part C), can help cover at least some of that home health care. Here’s what you should know.

Which types of home health care does Medicare cover?

Home health care coverage can fall under either Medicare Part A or Part B, depending on the reason that home health care is needed.

For example, if you need home health care that results from hospitalization, that would be covered under Medicare Part A (hospital insurance), she says. If you need home health care due to a medical issue, such as diabetes, then that would be covered under Part B (medical insurance).

Finding the Medicare coverage plan that’s right for your life and budget doesn’t have to be overwhelming — eHealth is here to help. Get started now.

Medicare will cover home health care services and products such as:

• Physical therapy, which can help treat injuries or diseases that have interfered with your ability to function day to day
• Occupational therapy, which helps you perform daily living activities such as dressing or bathing
• Speech-language services, which help you regain and strengthen your speech and language skills as well as swallowing abilities
• Injectable osteoporosis medications for women
• Durable medical equipment, including wheelchairs, walkers, and nebulizers
• Medical supplies for use at home

Medicare also covers some skilled nursing or health aide care, including:

• Part-time skilled nursing care (if it’s less than seven days a week or less than eight hours a day over a 21-day period)
• Part-time home health aide care (but this is only if you’re also getting other skilled nursing or therapy services during this time)

If you need these services, your doctor will typically order them for you. Then a Medicare-certified home health care agency will help coordinate your care.

These services are also covered under Medicare Advantage — a Medicare-approved plan run by private insurance companies. “If it’s a benefit that’s offered under Original Medicare, it has to be offered under Medicare Advantage too,” says Miller.

Which home health services won’t Medicare pay for?

Medicare doesn’t pay for all forms of home health care. It won’t, for example, cover:

• 24-hour care that takes place at your home
• Meal delivery services to your home
• Homemaker services such as shopping, cleaning, and laundry (such as dressing or using the bathroom) if this is the only type of care you need)

NEW TO MEDICARE?

Who may be eligible for home health aides under Medicare?

To be eligible for home health care coverage under Medicare, you have to meet certain conditions. For example, you must:

• Be under the care of a doctor who’s regularly reviewing your care plan
• Be homebound (and certified by your doctor that you’re homebound), meaning that you have trouble leaving your house without a walker or wheelchair
• Be certified by a doctor that you need one or more of these care services:
  • Intermittent skilled nursing care (other than drawing blood)
  • Physical therapy, speech-language pathology, or continued occupational services

You don’t have to stay in your home 24/7 to qualify as homebound, however. You can still leave the house occasionally to receive medical treatment or for short, non-medical events, such as religious services.

How much do home health services cost?

Under Medicare, you usually don’t have to pay anything for home health care coverage. However, if you need durable medical equipment (DME), you’ll typically pay 20% of the Medicare-approved amount after you meet your deductible. Before Medicare will approve the coverage, you’ll need a doctor who accepts Medicare to order this for you.

Your home health agency, which will work with you during this time, can also tell you which services Medicare covers and to what extent. If the agency gives you any “extra” supplies or services not covered by your insurance, it’ll let you know by giving you a notice called an Advance Beneficiary Notice (ABN). An ABN lists the items that Medicare won’t cover.

Getting home health services in certain states

If you live in Massachusetts, Michigan, Florida, Illinois, or Texas, you may be eligible for a Medicare demonstration program. Under this program, you (or your home health care provider) can request a pre-claim review to let you know early on whether Medicare coverage will likely cover your home health services.

If you’re a resident of one of these states, you might want to request a pre-claim review as soon as your doctor orders your home health care. This way, you’ll know as soon as possible whether you’ll be on the hook for any payments.

Ready to get started? Find a plan that fits your budget and covers your doctor and prescription medications now.  

Sources

1. Medicare.gov, Home Health Services, https://www.medicare.gov/coverage/home-health-services

2. Medicare & You 2022: The Official U.S. Government Medicare Handbook, https://www.medicare.gov/media/10991

3. Administration for Community Living, How Much Care Will You Need?, February 18, 2020, https://acl.gov/ltc/basic-needs/how-much-care-will-you-need

4. Medicare.gov, Occupational Therapy, https://www.medicare.gov/coverage/occupational-therapy

5. Medicare.gov, Speech-language Pathology Services, https://www.medicare.gov/coverage/speech-language-pathology-services