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 services include wound care, patient and caregiver education, injections, and monitoring of severe illness or unstable health.

Home health care can help people regain independence, maintain their current medical condition or level of function, get better, or slow their 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 provide personal care services for your husband, such as helping him bathe, go to the bathroom, get dressed, and meet 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 only part-time or intermittent care. The benefit enables care 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 also end.

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; 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, contact a local licensed Connie Health agent at (623) 223-8884.

Frequently Asked Questions

Does Medicare pay for home health aides?

Yes, Medicare may cover home health aides, but only under specific circumstances. Medicare Part A (hospital Insurance) and/or Part B (medical Insurance) provide coverage for part-time or intermittent home health aide services, but only if you qualify for home health care services. These services are typically focused on providing personal care, such as bathing, dressing, and grooming, rather than long-term care or around-the-clock assistance.

To qualify, the following conditions must be met:

• You must be under the care of a doctor, and your doctor must create a plan for your home health care.
• You must need skilled services, such as nursing or therapy, provided by a Medicare-approved home health agency.
• Your doctor must certify that you are homebound, meaning it’s difficult for you to leave your home without assistance due to illness or injury.

It’s important to note that Medicare does not cover 24-hour home health care or homemaker services like house cleaning, laundry, or meal delivery. If you need long-term personal care services, Medicaid or private insurance plans might offer additional options depending on your specific needs and eligibility.

If you have questions about your circumstances, call (623) 223-8884 to speak with a local licensed Connie Health agent.

Does Medicare pay for home health care aides?

Yes, Medicare Part A covers some home health care services, but it’s essential to understand the specifics. Medicare will pay for home health care if certain conditions are met, including that the care is medically necessary, prescribed by a doctor, and provided by a Medicare-approved agency. These services may include skilled nursing care, physical therapy, occupational therapy, and speech-language pathology services.

However, Medicare typically does not pay for a full-time personal or home health aide if their services are limited to help with daily living activities like bathing, dressing, or housekeeping. Coverage may include intermittent visits from a home health aide, but only if these visits are part of the medical care plan that Medicare has approved.

If you’re unsure whether a loved one qualifies or certain services are covered, it’s a great idea to check with Medicare or speak with a local licensed Connie Health agent at (623) 223-8884.

Will Medicare pay for a home health aide?

Medicare Part A may cover the cost of a home health aide, but it depends on the services you need and your eligibility. For Medicare to pay, you must require skilled nursing care or therapy services at home under a doctor’s recommendation. If you’re eligible, a home health aide can assist with personal care tasks such as bathing, dressing, or grooming as part of your Medicare-approved home health care plan.

However, it’s important to note that Medicare does not typically cover home health aide services if you only need help with daily activities like cooking or housekeeping.

If you’re unsure about your specific situation, we’d be happy to help you review your Medicare coverage and options. Don’t hesitate to reach out for assistance. Call (623) 223-8884 to speak with a local licensed Connie Health agent in your community.