Does Medicare cover home health aides?

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Dear Connie,

My husband has multiple chronic conditions. While we have specialists coming to the house to support him, I hope to get help with his daily personal care needs. It’s become overwhelming for me to manage. I’m wondering, does Medicare cover home health aides?

Seeking help,
Shirley from Spring Hill, Florida

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Dear Shirley,

I’m so happy you’re reaching out and seeking the support you need.

Yes, Medicare covers home health aides under certain conditions.

For example, if you were only seeking a home health aide and there weren’t other services being provided in the home, your husband would not be eligible. Home health aides are not offered as a stand-alone service through Medicare.

Agent tip:

“Home health aides are not offered as a stand-alone service through Medicare. To qualify, the Medicare beneficiary must also be receiving in-home skilled care.“

However, since it sounds like your husband is receiving either skilled nursing care, physical therapy, occupational therapy, speech-language pathology, or other home health services, he’d likely qualify.

Home health care provides services in your home for an illness or injury. Many home health care services include wound care, patient and caregiver education, injections, and monitoring of severe illness or unstable health.

Home health care can help regain independence, maintain the current medical condition or level of function, get better, or slow decline. A home health aide could help.

Home health aides are covered under Original Medicare Part A home health care benefits. To qualify, the home health aide would need to be part of a physician-ordered plan of care for your husband in your home.

Home health aides can support your husband with personal care services such as helping him bathe, go to the bathroom, get dressed, and other personal needs. Medicare will pay for the home health aide in full when combined with other skilled nursing or therapy services.

You should also meet these requirements:

• You are receiving services from a home health agency that complies with federal and state regulations for home health aides.
• The home health aide provides services that meet federal and state guidelines and is supervised by a skilled professional.
• The home health aide is certified or licensed and in good standing with your state’s regulatory agency.

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Medicare’s home health care benefit for a home health aide is for part-time or intermittent care only. The benefit enables care for up to seven days per week but no more than 28 hours weekly. There are instances where he could receive up to 35 hours per week, but that is at your doctor’s discretion and in limited circumstances.

Your husband could continue to receive home health care for as long as he qualifies. However, his home health care plan should be recertified by his doctor every 60 days, and the home health aide benefit should be included in his care plan. His doctor would have the right to make changes to his care plan depending on the level of care that is reasonable and necessary. Should skilled care end, the home health aide benefit would end as well.

Should your husband need help more than 28 or 35 hours per week, he would not be eligible for a home health aide. Original Medicare Part A does not cover 24-hour-a-day care in your home.

If you are enrolled in a Medicare Advantage plan (Medicare Part C), your plan would be required to provide the same level of care as Original Medicare Part A’s home health benefit.

I hope that this information was helpful and clarified your question on whether Medicare covers home health aides. Medicare can be confusing, and you do not have to handle it alone.

At Connie Health, we help you throughout your Medicare journey. If you need help walking through a plan’s benefits or finding the right one for your needs, contact a local licensed Connie Health agent at (623) 223-8884 (TTY: 711) for assistance.

Sources

Medicare & Home Health Care.

Last updated: February 24, 2023