Original Medicare covers home health care services such as skilled nursing care, physical therapy, and home health aides but it does not cover homemaker services like shopping or cleaning, nor will it cover care that helps you with activities of daily living such as bathing, dressing, or toileting.
What Medicare Covers
- Home Health Care: Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance) cover eligible home health care services if they meet specific criteria. The services must be ordered by a doctor and provided by a Medicare-certified home health agency. Covered services include:
- Skilled nursing care: Intermittent or part-time skilled nursing care provided by a registered nurse or licensed practical nurse.
- Physical therapy: Services to improve movement or function.
- Speech-language pathology services: Therapy to regain and strengthen communication skills.
- Occupational therapy: Assistance with regaining the ability to perform daily activities.
- Medical social services: Counseling and help finding community resources.
- Home health aide services: Part-time or intermittent personal care services (not custodial care).
- Durable Medical Equipment (DME): Medicare also covers medically necessary durable medical equipment prescribed by a doctor for use in the home, such as wheelchairs, hospital beds, and oxygen equipment.
What Medicare Does Not Cover
Medicare does not cover 24-hour-a-day home care, meal delivery services, homemaker services (such as shopping, cleaning, and laundry), or personal care services (bathing, dressing, and toileting) when those are the only services needed.
Finding Coverage for Uncovered Services
For services not covered by Medicare, there are several options:
- Medicare Advantage Plans (Part C): Some Medicare Advantage plans offer additional home health care benefits not covered by Original Medicare. Beneficiaries should check with their plan providers for specific coverage details.
- Medicaid: Individuals with limited income and resources might qualify for Medicaid, which can cover more extensive home health care and personal care services.
- Long-term care insurance: These policies can help cover services like personal and custodial care, both in the home and in a nursing facility.
- Community and state programs: Many communities offer low-cost or free services for seniors. State health departments or local Area Agencies on Aging can provide information on available resources.
- Private pay: For those who can afford it, hiring home health aides or other personal care workers out-of-pocket is an option.
While Medicare provides essential coverage for various home health care services, it has limitations, particularly regarding personal and custodial care. Exploring additional insurance options, state programs, and community resources can help fill the gaps, ensuring comprehensive care and support for those in need.
For help with Medicare plans – or any questions you may have about Medicare – contact AMAC’s Medicare Advisory Service at 1-855-611-4856 or request a call back below!