Does Medicare cover home health care?

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Dear Connie,

My father was recently diagnosed with diabetes. And he has other health conditions. My family and I are doing our best to care for his needs. As his regular caregivers, we could use some extra help to support his health and better understand how to manage his diabetes.

Someone suggested we look into home health care, but I don’t know where to start. We’re wondering, does Medicare cover home health care?

Seeking additional support,
Terry from Green Valley, Arizona

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Dear Terry,

I’m happy that you chose to reach out for help. Caregiving is a difficult task.

Based on your father’s diabetes diagnosis and possibly his other health conditions, he may be eligible for home health care services. I’ll help break down the eligibility and services offered in-home. These can help you decide if they may be a good fit for your father.

First, for your father to qualify for home health care, he must meet the eligibility criteria.

• Your father would need to be under the care of a doctor or qualified practitioner, and home health care is part of a care plan that is routinely reviewed.
• Your father’s doctor or qualified practitioner certifies that he is homebound.
• The home health agency providing the care is Medicare-certified.
• Your father’s doctor or other allowed practitioner certifies that your father needs some of the following care: intermittent skilled nursing care, physical therapy, speech-language pathology services, or occupational therapy.
• Your father does not need full-time skilled nursing care.
• His doctor or allowed practitioner has visited with him face-to-face within the required timeframes, and the reason was related to needing home health care.

Once he’s under the care of a doctor or qualified practitioner that certifies he needs home health care, he may get the following services, depending on his plan of care.

Agent tip:

“Home health care benefits are available for those who are homebound and under the care of a doctor or qualified practitioner. If you are a caregiver, know what support is available to advocate for care and support.“

Skilled nursing care

Skilled nursing care might be something you ask for because he has a recent diabetes diagnosis. A skilled nurse can come to his home and teach you and other caregivers about diabetes care and management.

Skilled nursing care can also include:

• Managing, observing, and evaluating care.
• Administering medications, including IV drugs.
• Providing certain injections or tube feedings.
• Changing dressings.
• Teaching about prescribed medications or diabetes care.
• Teaching your father and his caregivers about his care.

Medicare covers part-time or intermittent skilled nursing, meaning they come for fewer than eight hours per day and between 28 and 35 hours per week, depending on the situation. If a non-medical caregiver can safely and effectively provide a service without the supervision of a nurse, then it’s not skilled nursing care.

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Occupational therapy, physical therapy, and speech-language pathology services

Your father might be eligible to receive three other buckets of services as a home health benefit. These include physical therapy, speech-language pathology services, and occupational therapy.

These services are necessary for a home setting if they are:

• Specific, safe, and effective treatment of the condition.
• You can only get the services safely and effectively from a qualified therapist.
• The condition requires therapy to restore or improve functions affected by the illness or injury, maintain the current condition, and prevent it from worsening, or the amount, frequency, and duration of services are reasonable.

Other home health care

Suppose your father is getting any of the above skilled care (skilled nursing, occupational therapy, physical therapy, or speech-language pathology services). In that case, he may also be eligible for a home health aide, medical social services, and medical supplies needed during home care.

Read more about coverage and how to request a home health aide in “Does Medicare cover home health aides?”

A home health aide could help with personal care. At the same time, medical social services could support your father and caregivers with social and emotional concerns interfering with his treatment or the recovery rate. Medical social service providers can provide counseling or support in finding community resources.

Durable Medicare Equipment (DME), such as a wheelchair, would be covered under Medicare Part B, not home health care medical supplies. You would pay the Part B deductible and 20% of the Medicare-approved amount. Medicare Part B would pay the remaining 80% of the Medicare-approved supplies.

Original Medicare Part A provides coverage for home health care. Generally, what is owed is the Part A deductible and any services or supplies that are not Medicare-approved.

Learn more about what home health care is covered by Part A by reading “What is Medicare Part A and What is Covered?”

If your father is enrolled in a Medicare Advantage plan (Medicare Part C), his plan must provide the same coverage and care as Original Medicare Part A’s home health benefit.

I hope that we have answered your questions. The first step is reaching out to your father’s doctor. Now that you know your home health care options, you can advocate for his care, and the caregiver support you need.

You can speak with a Connie Health licensed agent in your community if you have additional questions. Call (623) 223-8884 for support throughout the Medicare journey.

Sources

Cost of Medicare Part B Premium, Deductible & More
Does Medicare cover home health aides?
Home health services
Medicare & Home Health Care
What is Medicare Part A and What Does it Cover?

Frequently Asked Questions

Does Medicare cover home health care for dementia?

Yes, Original Medicare Part A covers some home health care for dementia patients. If certified “homebound” by a doctor or other qualified professional, a dementia patient can receive up to 35 hours per week of home health care.

These services include skilled nursing care, hands-on care from a home health aide, physical therapy, occupational and speech-language therapy, and medical social services. If 24-hour care is needed, this would not be covered by Original Medicare Part A or B.

If you have questions about home health care for a loved one with dementia, call (623) 223-8884 to speak with a licensed agent in your community.

What does Medicare cover for home health care?

Original Medicare Part A home health care covers skilled nursing care, physical therapy, occupational therapy, speech-language therapy, home health aides, medical social services, and medical supplies. All services must be part of a home health care plan certified by a doctor or other qualified professional. And care is limited to 35 hours per week.

Does Medicare cover home health care for cancer patients?

Yes, Original Medicare Part A pays for some home health care for people with cancer.

Cancer patients can receive up to 35 hours a week of help in their home. This help may include nurses, aides, physical and speech therapy, and more. If you need 24-hour care, this is not covered by Original Medicare Parts A or B. If you have questions about care for someone with cancer, call (623) 223-8884 to speak with a local licensed agent who can help.

How many hours of home health care does Medicare cover?

Original Medicare Part A covers fewer than eight hours per day and 28 hours of home health care per week. In some cases, coverage for 35 hours per week is possible. The doctor or qualified professional coordinating the home health care plan will determine the weekly hours.