Does Medicare Cover Home Health Care?

Home health care aims to provide treatment for an illness or injury within the comfort and privacy of your home.

If you qualify, Medicare covers a range of services if they’re reasonable and necessary for your treatment.

About 12,000 home care agencies provided care to 3.4 million Medicare beneficiaries in 2017, according to Kaiser Health News.

Medicare beneficiaries must meet certain eligibility requirements in order to qualify for home health care.

While Medicare pays for many aspects of home health, not all services are covered.

If you’re eligible, Original Medicare (Part A and Part B) will pay all costs for home health care services ordered by a doctor and provided by a certified home health agency.

Medicare pays the full cost of home health care for up to 60 days at a time. Medicare can continue to cover costs as long as your doctor recertifies every 60 days that the home services are still medically necessary.

You will be responsible for a 20 percent copayment for the Medicare-approved amount for durable medical equipment.

Before your care begins, the home health agency should disclose how much Medicare will pay. The agency should also inform you when items or services are not covered by Medicare, and how much you’ll owe.

If you meet the criteria for Medicare home health care, you may not have any coinsurance or copayments.

Since Medicare Supplement plans, also known as Medigap, typically pay coinsurance or copayments, your Medicare Supplement plan may not be necessary to cover the costs of home health care.

However, a Medigap plan can help cover the 20 percent copay for durable medical equipment.

If you have a Medigap policy or other health coverage, tell your doctor or health care provider so your services are billed correctly.

All Medicare Advantage plans (Part C) must provide at least the same level of home health care coverage as Original Medicare. However, plans may impose different rules, restrictions and costs.

For example, while Original Medicare fully covers home health costs for those who qualify, some Medicare Advantage plans may require you to pay a copayment for your care.