Home health care provides a range of medical services in the comfort of your own home, often proving to be a convenient and cost-effective alternative to hospital or skilled nursing facility care. If you’re wondering, Does Medicare Part B Cover Home Health Care?, the answer is yes, under specific conditions. Both Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) can cover eligible home health services, but primarily, Part B plays a significant role.
Medicare can cover these services if you require part-time or intermittent skilled care and meet the definition of being “homebound.” Being homebound doesn’t mean you can never leave your house, but it does mean leaving your home is challenging. Specifically, you’re considered “homebound” if:
- You struggle to leave home without assistance due to an illness or injury. This assistance could be in the form of mobility aids like a cane, wheelchair, walker, or crutches, special transportation, or help from another person.
- Your doctor advises against leaving your home due to your health condition.
- Leaving home is a significant effort for you.
If you meet these homebound criteria and require skilled care, Medicare Part B can help cover a variety of home health services.
What Home Health Services Does Medicare Part B Cover?
Medicare Part B coverage for home health care encompasses a range of services deemed medically necessary. These services are provided on a part-time or intermittent basis and must be ordered by a doctor or a certified health care provider. Covered services include:
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Skilled Nursing Care: This includes medically necessary part-time or intermittent skilled nursing services, such as:
- Wound care for pressure sores or surgical wounds.
- Education for patients and caregivers on managing health conditions.
- Intravenous (IV) or nutrition therapy.
- Injections.
- Monitoring serious illnesses and unstable health status.
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Therapy Services:
- Physical Therapy: To help regain movement and manage pain.
- Occupational Therapy: To assist with daily living activities.
- Speech-Language Pathology Services: To address speech and swallowing difficulties.
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Medical Social Services: To provide counseling and support related to your medical condition.
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Home Health Aide Services: Part-time or intermittent assistance from a home health aide is covered, but only if you are also receiving skilled nursing care or therapy services (physical, occupational, or speech therapy) at the same time. Home health aide services can include help with:
- Walking and mobility.
- Bathing and grooming.
- Changing bed linens.
- Feeding.
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Other Covered Services and Equipment:
- Injectable osteoporosis drugs for women.
- Durable Medical Equipment (DME) like wheelchairs or walkers.
- Medical supplies for use at home.
- Disposable negative pressure wound therapy devices.
It’s important to note that a physician or a qualified health care provider must conduct a face-to-face assessment to certify your need for home health services. They must also create a plan of care, and the services must be delivered by a Medicare-certified home health agency.
To find agencies in your area, your provider should give you a list of Medicare-certified home health agencies. You can also use the Medicare Care Compare tool to search for agencies in your area.
What Home Health Services Are Not Covered by Medicare Part B?
While Medicare Part B offers substantial coverage for home health care, it’s crucial to understand what it does not cover. Medicare typically does not pay for:
- 24-hour-a-day care at home: Medicare is designed for part-time or intermittent care, not continuous around-the-clock supervision.
- Home meal delivery: Meal services like Meals on Wheels are not covered.
- Homemaker services: Services like shopping and cleaning that are not directly related to your medical care plan are not covered.
- Custodial or personal care alone: If you only require assistance with daily living activities such as bathing, dressing, or using the bathroom and do not need skilled care, Medicare will not cover home health care. Custodial care is only covered when it is part of the skilled care you are receiving.
Additionally, if you require more than part-time or intermittent skilled care, you may not qualify for the home health benefit. While you can leave home for medical appointments or short, infrequent outings for non-medical reasons (like religious services), and still receive home health care, the primary focus is on care provided to individuals who are predominantly homebound. Attending adult day care also generally does not disqualify you from receiving home health care.
Understanding what Medicare Part B covers for home health care can help you access the services you need while managing your healthcare costs effectively. If you believe you or a loved one may qualify for home health care under Medicare Part B, discuss your needs with your doctor to determine the best course of action.
