Medicare covers Home Health Care, as long as you meet all of the eligibility requirements. Home health care is care provided to you in the home to treat an illness or injury.
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How does Medicare pay for Home Health Care?
Medicare and Home Health Care: Eligibility
If you have Medicare, you can use your home health benefits if you meet all the following conditions:
- You must be homebound, i.e.
- You have trouble leaving your home without help because of an illness or injury, AND
- Leaving your home isn’t recommended because of your condition, and you are normally unable to leave your home because it’s a major effort
- You must require part-time or intermittent skilled nursing care, and/or physical therapy, speech pathology services, or occupational therapy
- A doctor must see you face-to-face and certify your need for home health services
- The home health care must be provided by a Medicare-certified home health agency. You may find a list of home health care agencies in your area on Medicare.gov
The recent changes allow you to qualify for home health care just to maintain your condition and to prevent your health from getting worse, not necessarily to improve it.
Medicare and Home Health Care: How Medicare pays for home health care
In Original Medicare, Medicare pays your Medicare-certified home health agency one payment for covered services you get during a 60-day period. This 60-day period is called an “episode of care.” The payment is based on your condition and care needs.
Getting treatment from a home health agency that’s Medicare-certified can reduce your out-of-pocket costs. A Medicare-certified home health agency agrees to the following conditions:
- To be paid by Medicare
- To accept only the amount Medicare approves for their services
Medicare’s home health benefit only pays for services provided by the home health agency. Other medical services, such as visits to your doctor, are generally still covered by your other Medicare benefits.
Medicare and Home Health Care: What Medicare covers
Medicare Part A pays 100% of your covered home health care, and there is no limit on the number of visits to your home that Medicare will pay for. If you require durable medical equipment, Medicare will pay 80% of the costs.
If you’re eligible for Medicare-covered home health care, Medicare covers the following services if they’re reasonable and necessary for the treatment of your illness or injury:
- Skilled nursing care. Skilled nursing services are covered when they’re given on a part-time or intermittent basis. In order for skilled nursing care to be covered by the Medicare home health benefit, your care must be necessary and ordered by your doctor for your specific condition. You must not need full time nursing care and you must be homebound. Skilled nursing services are given by either a registered nurse (RN) or a licensed practical nurse (LPN).
- Physical therapy, occupational therapy, and speech-language pathology services.
- Medical social services.
- Medical supplies.
If your home health care includes skilled nursing care, Medicare will also pay for home health aide services (e.g., help with bathing, dressing, and using the bathroom). Otherwise, Medicare will not pay for home health aide services.
US Government Sources
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