Is your home healthcare covered by Medicare

Stephanie Jackson | Finances, Home Care & Home Healthcare, Aging in Place, | October 06, 2016

If you're a senior who struggles with maintaining your health and well-being on your own, you might be considering the help of a home health aide. Seniors over 65 may also be wondering what kinds of home health care benefits are covered under Medicare. Below we will break down who is eligible for Medicare coverage of home health services and actions you can take to get the care you need.

Eligibility, Medicare and home health
According to the Centers for Medicare & Medicaid Services, home health services have become increasingly popular for Medicare recipients, as they typically cost less and offer the same high level of care. Many home health services focus on preventative care to also reduce acute care costs and help seniors become more independent.

Medicare does cover some types of home health services.

Medicare does cover some types of home health services.

As a result, Medicare does allow seniors to attain home health coverage, but you have to be eligible to receive these services. Here are a few requirements you'll need to receive home health care, according to CMS:

  • The home health care plan must be reviewed and established regularly by your doctor.
  • A doctor must verify that you require one or more of the following: intermittent skilled nursing care, physical therapy, speech-language pathology or occupational therapy.
  • The agency you choose must be Medicare-certified.
  • A doctor must confirm that you are homebound, meaning it is not recommended you leave your home due to a condition (this excludes infrequent absences from home, such as attending religious services once a week or adult day care).


What exactly is covered under Medicare's home health policy?
If you meet these requirements, you will not be expected to pay for home health care services per Medicare's policy, according to CMS. Additionally, Medicare will cover 20 percent of the amount approved from Medicare to be put toward durable medical equipment used while at home. Regardless of your home health needs, each agency should explain in full detail what is and what's not covered under these policies based on your condition, also known and the "Home Health Advance Beneficiary Notice."

Skilled nursing care is also covered when administered on a part-time or intermittent basis. Skilled nurses are defined as registered nurses and licensed practical nurses. Some of the treatments you may expect from these medical professionals include changing dressings, informing you about your prescriptions or diabetes treatments, administering IV drugs or shots, as well as tube feedings, if necessary.

Skilled nursing care is covered under Medicare if on a part-time or intermittent basis.

What isn't covered under Medicare's home health policy?
CMS also stated that the home health policies under Medicare only direct revenue to the services you need from your chosen agency. However, doctor visits and other routine appointments are generally already covered by existing Medicare benefits. Meals, 24-hour care, housekeeping services like cleaning, shopping, and personal care like bathing and dressing, generally are not paid for under Medicare policies.

You have the right to appeal
CMS also indicated that once covered home health plans come to an end, Medicare recipients have the right to a fast appeal. During this process, a quality improvement organization (QIO) will review your treatment plan and determine if you still require home health services. Under Medicare policy, the home health agency will send you a written notice at least two days before your home health treatment is scheduled to end, and it will also give you a breakdown of how you can appeal.

Home health services are a part of your care plan as a senior if you need them, so it's important to understand what is and is not covered under your Medicare plan. If you need more information about home health services and Medicare, be sure to contact your doctor or home health agency.