You are here: Home Day to Day Living Home Health Care ... Paying For Home ... Medicare And Home Health ...
Information about all aspects of finances affected by a serious health condition. Includes income sources such as work, investments, and private and government disability programs, and expenses such as medical bills, and how to deal with financial problems.
Information about all aspects of health care from choosing a doctor and treatment, staying safe in a hospital, to end of life care. Includes how to obtain, choose and maximize health insurance policies.
Answers to your practical questions such as how to travel safely despite your health condition, how to avoid getting infected by a pet, and what to say or not say to an insurance company.

Paying For Home Health Care

Medicare And Home Health Care

Next » « Previous


The original fee-for-service Medicare plan pays for the costs of many home health care services. Home care may continue as long as your doctor indicates that it is medically necessary. 

In order for Medicare to pay:

  • Your doctor must:
    • Confirm that you need medical care in your home.
    • Determine what services will be required.
    • Decide what type of health care professional is needed to provide each service.
    • How often the services will be required.
  • You must need at least one of the following services:
    • Skilled nursing care
    • Physical therapy
    • Speech therapy
    • Occupational therapy
  • You must need the services, as Medicare says, on an "intermittent" (starting and stopping) and part time only basis.
  • You must be homebound. This means that you are normally unable to leave home and doing so is a major effort. Trips away from home must be infrequent and for a short period of time. Leaving home to receive medical care or to attend religious services is allowed.
  • The home health agency providing care must be Medicare approved.

A review is required at least every 60 days for care to continue.

Medicare covers the following services:

  • Skilled nursing services: Services that can only be performed safely by a licensed or registered nurse. Skilled nursing services must be needed on a part-time or intermittent basis (skilled nursing and home health aide services combined, are not to exceed 8 hours per day and 28 or fewer hours each week).
  • Home health aide services are designed to provide support care to the nurse. Services must only be required on a part-time or intermittent basis (home health aide and skilled nursing care services are not to exceed 8 hours per day and 28 or fewer hours each week). Only the agency supplying nursing care can provide home health aide services and be paid for by Medicare.
  • Physical Therapy services can continue as long as your doctor indicates they are necessary.
  • Speech Therapy services can continue as long as your doctor indicates they are necessary.
  • Occupational Therapy services can continue as long as your doctor indicates they are necessary.
  • Medical Social Services.
  • Medical Supplies.
  • Medical equipment is covered at 80% of the Medicare approved charge. Patients are responsible for the remaining 20%. Some companies will waive the 20% payment when requested, particularly if a patient is experiencing financial hardship. This is known as "accepting assignment."

Original fee-for-service Medicare does not pay for the following services:

  • 24-hour care.
  • Prescription drugs. Prescription drugs can be covered by Medicare Part D.
  • Meals delivered to your home. Medicare may pay for some nutritional supplements when medically necessary.
  • Homemaker services such as shopping, cleaning, and laundry.
  • Home Health Aide services when skilled nursing care is not required.

For additional information call 800-MEDICARE or visit offsite link

Medicare Advantage (Medicare Managed Care Plans): If you belong to a Medicare managed care plan, you may only receive care from a home health agency that is contracted to work with the managed care plan. If you receive services from a doctor or home health care agency that doesn't work with the managed care plan, neither the plan nor Medicare will pay the bill.

The qualifying criteria, and services provided, for home health care vary by insurer. However, they are generally similar to those provided by the original Medicare plan as described above. Review your plan or call your insurer to confirm participating home health agencies, and to receive specific plan information.

If you are told that your plan does not cover home care, or the home care you need, check with Medicare to find out if such care is a Medicare requirement even if it not stated in your policy. You can contact Medicare at 800.MEDICARE (800.633.4227)

Please share how this information is useful to you. 0 Comments


Post a Comment Have something to add to this topic? Contact Us.

Characters remaining:

  • Allowed markup: <a> <i> <b> <em> <u> <s> <strong> <code> <pre> <p>
    All other tags will be stripped.