Sometimes you may need additional help with your health at home due to an injury, chronic condition, or an inability to leave your home for any reason. A multitude of resources are available to keep you safe and healthy at home; we can help you understand which home health care services are covered by Medicare.
Does Medicare Pay for In-Home Health Care?
In short, yes. Many in-home health care services are covered by Medicare Parts A and B (Original Medicare) and additional services may be available with some Medicare Advantage Plans.
What Home Health Care is Covered by Original Medicare?
A number of in-home health care services are covered by Original Medicare if they’re deemed medically necessary, including:
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Part-time or intermittent skilled nurse care (less than 7 days/week, less than 8 hours/day, less than 3 weeks total)
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Physical therapy
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Occupational therapy
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Speech-language pathology
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Durable medical equipment
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Medical supplies for home
Keep in mind that your eligibility may be dependent upon these home health care services being ordered by your doctor as part of a goal-oriented treatment plan. The services must be provided by a Medicare approved agency, and your doctor must verify that you are homebound. The Centers for Medicare & Medicaid Services (CMS) defines homebound as being unable to leave without help (assistive devices, special transportation, another person); that definition does allow for attending medical treatments and religious services.
Are You Eligible for a Medicare Advantage Plan with Additional Benefits?
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What’s Covered by Medicare Advantage (Part C)?
Medicare Advantage plans are offered by private insurance companies. They include all the same benefits as Medicare Parts A and B and may offer additional benefits as well.
Since 2018, the Centers for Medicare and Medicaid Services (CMS) has expanded the definition of health-related supplemental benefits to include additional services “that increase health and improve quality of life, including coverage of non-skilled, in-home supports” as well as “address social determinants of health for people with chronic disease.” These changes are aimed at helping to prevent complications from surgery or illness, as well as reducing the need for emergency services and preventing hospital stays.
That means that Medicare Advantage Plans can now offer more in-home health care benefits, such as:
Medicare Advantage plans, which are offered by private insurance companies, include the same coverage as Original Medicare and often provide additional benefits as well, such as dental, vision, hearing, and prescription drug coverage.
The Centers for Medicare and Medicaid Services (CMS) carefully regulate which benefits Medicare Advantage plans can offer. CMS recently expanded the permissions for benefits related to long-term care and in-home care. Carriers are still adding these new benefits to their Medicare Advantage plans, and available benefits vary based on the plans in your area.
Some benefits include:
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Support services – someone to assist with your care at home
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Palliative care
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Caregiver support
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Therapeutic massage
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Adult day center access
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Safety equipment, such as grab bars
Additionally, for chronically ill members, usually restricted to Chronic Special Needs Plans, carriers may offer:
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Transportation
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Home cleaning
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Meal delivery
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Nutrition assistance
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And more!
Looking for Additional Benefits?
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Enrollment Eligibility
Annual Enrollment Period (AEP)
Medicare Annual Enrollment Period runs each year from October 15 to December 7. What is the Annual Enrollment Period vs. Open Enrollment Period?
Initial Enrollment Period (IEP)
Your Initial Enrollment Period generally surrounds your 65th birthday but may occur if you otherwise become eligible for Medicare for the first time.
Special Enrollment Period (SEP)
You may be eligible if you experience a qualifying life event such as moving to a new zip code, losing employer coverage, or change in Medicaid status.
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