Does Medicare Cover Home Health Care? What Seniors Need to Know

Home health care is one of the most misunderstood Medicare benefits. Many seniors assume Medicare will pay for a home health aide to help with daily activities -- and are shocked to discover it won't. Others who genuinely qualify for covered home health services don't know they're entitled to them.

Here's the truth about what Medicare covers.

Medicare covers home health care when ALL of the following conditions are met:

1. You are homebound. You must have difficulty leaving home without assistance, or leaving home requires considerable effort. You can still leave home occasionally for medical appointments, religious services, or adult day programs and still be considered homebound.

2. You need skilled care. Medicare covers home health only when you need skilled nursing care or skilled therapy services -- not just help with daily activities. Skilled services include:

• Skilled nursing (wound care, IV medications, injections, monitoring complex conditions)
• Physical therapy
• Occupational therapy
• Speech-language pathology
• Medical social services

3. Your doctor orders the care. A doctor or other qualified healthcare provider must certify that you need home health services and create a plan of care.

4. The agency is Medicare-certified. The home health agency must be approved by Medicare.

When you qualify, Medicare Part A or Part B covers 100% of approved home health services -- no deductible, no copay. This includes:

• Skilled nursing visits
• Physical, occupational, and speech therapy
• Medical social services
• Part-time or intermittent home health aide services (only when you're also receiving skilled care)
• Medical supplies used in the home

This is where many seniors are disappointed:

Custodial care is NOT covered. Help with bathing, dressing, grooming, meal preparation, and housekeeping is not covered by Medicare -- even if you need it. This is called "custodial" or "personal" care, and Medicare only covers it as a supplement to skilled care.

24-hour home care is NOT covered. Medicare covers part-time or intermittent skilled care, not around-the-clock care.

Homemaker services are NOT covered. Grocery shopping, cleaning, and cooking are not Medicare benefits.

There's no set limit on the number of home health visits Medicare covers, as long as you continue to meet the eligibility criteria (homebound, needing skilled care, under a doctor's plan of care). However, Medicare does review cases periodically to confirm you still qualify.

If you need ongoing help with daily activities -- bathing, dressing, eating, toileting -- but don't need skilled care, Medicare won't cover it. Options include:

• Medicaid: Covers custodial home care for low-income seniors
• Long-term care insurance: Covers custodial care if you purchased a policy
• Veterans benefits: VA provides home care for eligible veterans
• Private pay: Out-of-pocket costs for home health aides average $20-$25/hour

Medicare Advantage plans must cover the same home health benefits as Original Medicare. Some MA plans offer additional home support services beyond what Original Medicare covers -- check your plan's Evidence of Coverage for details.

We do not offer every plan available in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.