Will Medicare Cover Home Health Services?

Medicare covers a lot, including home health services, but before we discuss coverage, let’s first discuss what home health care entails. This type of care involves care that can be provided to you within your home, either for an injury or an illness. Home health care is typically less expensive but just as effective and more convenient than the care you receive in a hospital or other facility.

Home Health Services Covered by Medicare

Home health services are covered by both Medicare Part A and Part B. Some of the services that may be covered include but are not limited to:

• Part-time skilled nursing care
• Physical and/or occupational therapy
• Part-time or intermittent home health aide services
• Injectable osteoporosis drugs for women

What Medicare Won’t Cover

Medicare doesn’t cover:

• 24-hour-a-day care at home
• Meal delivery
• Homemaker services when it’s the only care you need
• Custodial or personal care when it’s the only care you need

In other words, anything necessary for daily living activities—things like eating, dressing, or things most can accomplish on their own—are not covered. If it is something that you cannot perform yourself—such as therapy, medications, etc. Otherwise, you’ll have to pay entirely out-of-pocket.

Home Health Coverage Eligibility

All people with Part A and/or Part B who meet all of these conditions are covered:

• Your doctor must consistently update your medical needs. Because covered services must be considered “medically necessary,” your needs must be current and checked up on to see if your needs have increased, decreased, or stayed the same.
• A doctor must certify that you need one or more of these:
  • Intermittent skilled nursing care
  • occupational therapy services, speech-language pathology, physical therapy
• You must be homebound.

So, the takeaway for coverage for home health services is that a doctor must certify your homebound condition.

How Much is Covered

If you are certified for coverage, how much will Medicare ultimately cover? The good news is that you will pay $0 for home health care services—so you are covered.

Home health services can also include durable medical equipment, medical supplies for use at home, or injectable osteoporosis drugs. For durable medical equipment (DME), you will pay 20% of the Medicare-Approved Amount. This is simply what the doctor approves, and Medicare pays the remaining 80%.

There may be slight differences in coverage depending on other insurance you may have (i.e., Advantage, supplements, etc.), how much your doctor charges, whether your doctor accepts the assignment, and where you get your test, item, or service.

Free Medicare Help, Call Jersey Medicare Solutions

We’re here to help you, always. For any questions or help with your coverage, call Jersey Medicare Solutions at 1-800-549-6804 or email Info@JerseyMedicareSolutions.com.