Watch Phil Capriotti on The Wealth Council

Sundays @ 1PM on Fox Business

LEARN MORE
CLIENT PORTAL

Home health care through Medicare

It’s important to plan for your health care needs, but sometimes life throws unexpected curve balls. And when that happens, you’ll need to know what’s covered. Fortunately, there are ways you and your loved ones can get the necessary care at home. Here’s what you need to know about in-home care for those with Medicare.

What is home health care and does Medicare cover it?

Home health care is a range of health care services given in your home for an illness or injury – like physical therapy or care from a home health aide. Medicare Part A or Part B covers these services at 100% for those that are eligible and if they’re required for treatment.

You might also need certain types of durable medical equipment, like a wheelchair or a commode chair. For these types of equipment, you’ll generally pay 20% of the Medicare-approved cost.

Home health care services covered by Medicare

  • Skilled Nursing care (when given on a part-time or intermittent basis)
  • Care from a home health aide (helps with daily activities if skilled care is needed)
  • Medical social services (counseling, help finding community resources)
  • Medical supplies (wound dressings)
  • Necessary durable medical equipment (walker, wheelchair, hospital bed)
  • Physical, occupational and speech language therapy

Home health care services not covered by Medicare

  • 24-hour-a-day care at home
  • Meal delivery
  • Homemaker services (help with shopping, cleaning, laundry) – if this is the only care you need
  • Personal or custodial care (help with bathing, dressing, using the bathroom) – if this is the only care you need

If you have a private Medicare health plan, check to see which home health care services are covered.

Who is eligible for home health care coverage?

Depending on your circumstances, Medicare covers certain in-home services. Those who have Medicare Parts A and B are covered by Medicare’s home health benefit when all the statements below are true:

  1. Your doctor says you need at least one of the following services at home (intermittent skilled nursing care, physical, speech-language or continued occupational therapy)
  2. You have a care plan that your doctor reviews regularly
  3. Your doctor confirms that you’re homebound (see definition below)
  4. You’re being cared for by a Medicare-certified home health agency
  5. You’re expected to improve within a reasonable period of time or you need a skilled therapist to improve your condition

What is Medicare’s definition of homebound status?

Medicare considers you homebound if both of these conditions are true.

  1. You need help when leaving home. This may be help from another person, durable medical equipment (like a walker or wheelchair) or use of special transportation. Alternatively, you have a condition such that leaving home is against medical advice.
  2. You must have an ongoing inability to leave home – not just for a day or two. Your trips out of home must be infrequent and short, because leaving home requires considerable effort and is very tiring.

Your doctor and home health agency (HHA) will evaluate your condition to certify if you are homebound. Every 60 days your doctor needs to re-evaluate and re-certify your care plan. If you aren’t declared homebound or recover from being homebound, you can receive medical care by visiting doctors and other health care providers. Or, you can take advantage of a remote care option like Virtuwell online clinic.

Being homebound doesn’t mean that you’re not allowed to leave home. You can still leave home for special occasions outside of health care, like religious services, family reunions, funerals, occasional trips to the barber or beauty parlor and more.

https://www.healthpartners.com/blog/medicare-home-healthcare-coverage/

Share:

View the Latest Posts:

Before Your Next Appointment: 5 Medicare Questions That Can Help Prevent Costly Surprises

You schedule an appointment, hand over your insurance card, and assume your coverage will take care of the rest. Then a bill arrives—or the pharmacy tells you that your new prescription needs approval. Understanding your Medicare coverage before you use it can help you prepare for expenses, address paperwork, and ask better questions. Whether you are new to Medicare or have had coverage for years, these five questions are worth keeping handy. 1. Can I Use This Doctor With My Coverage? “Do you take Medicare?” is a starting point, but the next question depends on how you receive your benefits. With Original Medicare, you can generally use doctors and hospitals that accept Medicare throughout the United States. Ask whether the provider accepts assignment, meaning they agree to accept the Medicare-approved amount as full payment for covered services. With Medicare Advantage, you may need to use your plan’s network for non-emergency

7 Medicare Enrollment Mistakes to Avoid When Turning 65

Turning 65 is an exciting milestone—but it also brings important Medicare decisions. With multiple enrollment periods, coverage options, and deadlines to understand, even a small mistake could lead to delayed coverage, unexpected expenses, or lifelong penalties. Here are seven common Medicare enrollment mistakes and how you may be able to avoid them. 1. Assuming Medicare Enrollment Is Always Automatic Some people are automatically enrolled in Medicare Parts A and B, while others must enroll themselves. If you are already receiving Social Security or Railroad Retirement Board benefits before turning 65, enrollment may happen automatically. If you are not receiving these benefits, you will generally need to sign up for Medicare. Do not assume your coverage will begin automatically. Confirm your enrollment status before your 65th birthday. 2. Missing Your Initial Enrollment Period Your Medicare Initial Enrollment Period is a seven-month window that generally includes: The three months before your 65th

Original Medicare vs. Medicare Advantage: What Should You Choose at 65?

As your 65th birthday approaches, you will have several important Medicare decisions to make. One of the biggest is choosing how you want to receive your Medicare benefits. Should you select Original Medicare, or would a Medicare Advantage plan better fit your needs? Both options can provide valuable healthcare coverage, but they work very differently. The right choice depends on your doctors, prescriptions, budget, travel plans, and personal preferences—not simply on which option has the lowest advertised premium. Here is what you should understand before making your decision. First, What Is Original Medicare? Original Medicare is the traditional federal Medicare program. It includes: Medicare Part A, which generally helps cover inpatient hospital care, skilled nursing facility care, hospice care, and certain home healthcare services. Medicare Part B, which generally helps cover doctor visits, outpatient care, preventive services, medical equipment, and other medically necessary services. With Original Medicare, you can generally

Medicare Wellness Visits Explained: What Is Covered—and What Is Not

When you become eligible for Medicare, you may hear several similar-sounding terms: the “Welcome to Medicare” visit, the Annual Wellness Visit, and a routine physical exam. Although these appointments can all play a role in managing your health, they are not the same—and Medicare may cover them differently. Understanding the distinction before scheduling an appointment can help you ask the right questions, make better use of your benefits, and avoid unexpected costs. The “Welcome to Medicare” Preventive Visit The “Welcome to Medicare” preventive visit is a one-time appointment available during the first 12 months that you have Medicare Part B. This visit is designed to establish a baseline for your health and create a preventive-care plan. Your provider may review your medical and social history, discuss screenings and vaccines, check basic measurements, perform a simple vision test, assess certain health risks, and provide a written checklist of recommended preventive services.