Does Medicare Pay For Home Health Care?

Home health care refers to any form of healthcare provided at home for people living with certain medical conditions, and includes physical therapy, skilled nursing services and home health aides. Medicare only covers home health care that has been certified as medically necessary – meaning a doctor must conduct an in-person assessment and certify the need for home health care on a regular basis.

If a person does not have enough income to cover home health care, Medicaid could provide assistance through its joint federal/state program that offers health insurance to low-income individuals. Unfortunately, Medicaid often comes with restrictions which limit what home health services will be covered.

Medicare Part A requirements require that an individual must first spend at least three days in either a hospital or skilled nursing facility prior to receiving home health care services. Furthermore, their physician must oversee their care at home and recertify on an ongoing basis that home health services remain necessary.

Home health care offers many advantages for anyone recovering from injury or illness, compared to traditional nursing facilities or hospitals. Furthermore, its tailored nature allows each individual patient to meet his/her individual goals faster – potentially speeding up recovery process.

Individuals enrolled in either Original Medicare or one of the Medicare Advantage plans will differ in what services they qualify for regarding home health care. While Original Medicare only offers limited home health services coverage, Medicare Advantage plans offer more comprehensive protections to assist with daily activities of living.

Medicare will cover most costs related to home health care for most people who need it for up to 100 days after an acute hospital stay, or up to 21 days for intermittent home health services like physical therapy and speech-language pathology; it also offers medical social services and durable medical equipment like walkers.

Medicare Advantage plans may offer more extensive home health care coverage than Original Medicare; however, this benefit should not be assumed across all plans; before making your choice it is important to assess all available plans carefully and compare what each has to offer before deciding. Medicare will not pay for 24-hour-a-day homecare services or meal delivery services that do not pertain directly to your care plan. For more information about these limitations, it’s wise to speak with both a home health care professional and Medicare representative. An online Medicare benefits calculator may also help estimate costs associated with various home health services. In addition, Medigap insurance – private health coverage that fills gaps within Medicare coverage – could also be considered.


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