Medicare Coverage for Home Healthcare (2024)

Medicare parts A and C help cover home healthcare, such as rehabilitation, medical equipment, and nursing visits. Your coverage will depend on which Medicare parts you have and your plan. You will also need to meet certain criteria to use your coverage.Medicare provides coverage for a range of home health services, such as nursing visits, rehabilitation therapies, and medical supplies.

However, Medicare coverage is split into parts, and each covers different types of healthcare. This means that you must have the right Medicare part for the specific home health services you need.

Medicare also has criteria that you need to fulfill before it will cover a home health service.

Read on to learn more about Medicare’s coverage for home healthcare, including covered services, costs, and coverage limitations.

Medicare can help cover a range of home health services, as long as they are medically necessary to manage or treat a condition.

However, you may still need to pay some of the costs of each service yourself.

Medicare Part A provides coverage for part-time and semi-regular nursing care, such as:

• wound care
• nutrition therapy, including tube feeding
• therapies involving an intravenous (IV) drip
• injections
• monitoring of serious conditions
• education for you or your caregivers

This includes care from a registered or licensed practical nurse.

Medicare won’t cover home nursing care if it is a one-time service, such as having blood drawn once.

Learn about Medicare’s at-home hospice coverage.

Part A Medicare may also help cover rehabilitation therapies like:

• physical therapy
• occupational therapy
• speech-language therapy

Medicare will cover these therapies if they are:

• complex enough that only a qualified therapist needs to provide or supervise them
• relevant, safe, and effective for your health condition
• needed to improve or restore body functions
• required to help you maintain your health or stop it from worsening

If you’re getting skilled care, Medicare Part A may also help cover home health aide services. Skilled care includes skilled nursing and physical, occupational, and speech-language therapies.

Home health aide care can include help with:

• feeding
• walking or moving around the house
• bathing, dressing, or other grooming
• changing bedsheets

Medicare Part B helps cover certain medications, supplies, and durable medical equipment (DME). Examples include:

• blood sugar test strips and monitors
• nebulizers and nebulizer medications
• oxygen equipment
• infusion pumps and supplies, like catheters and tubing
• continuous passive motion machines
• continuous positive airway pressure machines
• suction pumps
• traction pumps
• home aids, such as commode chairs, hospital beds, and hoists
• mobility aids, such as crutches, walkers, and wheelchairs
• prosthetic and orthotic equipment, such as braces, ostomy bags, and artificial limbs

Learn more about Medicare’s DME coverage, including its costs and limitations.

Medicare Part A covers certain social services if a qualifying medical professional orders them and you’re getting skilled care.

A medical professional may order a social service if they think social or emotional factors could be affecting your treatment or recovery.

Examples of Medicare-covered social services include counseling and help finding local or community resources.

Medicare Part C plans are an alternative to government-provided Original Medicare. Instead, they are provided by private insurance companies.

All Part C plans cover the same essential services as Medicare parts A and B, including home health services. Some Part C plans even offer extra benefits.

To check your coverage, contact a Part C plan insurer directly.

Learn more about Medicare Part C coverage and costs.

Home healthcare that Medicare does not cover includes:

• 24-hour home care
• meals delivered to your address
• services like laundry, shopping, and cleaning
• help with personal care, such as dressing or going to the bathroom (if it’s the only care you need)
• one-time skilled nursing care

For Medicare to cover home healthcare, you must meet criteria in the following areas:

• Medicare parts: You must have the right Medicare part for the care you need. For example, you may not be covered for DME if you don’t have Medicare Part B. Alternatively, if you don’t have Medicare Part A, you may not be covered for home health care.
• Medical necessity: Medicare covers home health services if a qualified medical professional confirms they are necessary and that the care you need requires a nurse or therapist.
• Home health agencies: A Medicare-approved home health agency has to provide the services. Medicare will cover your care from only one agency at a time.
• Accepting assignment: The medical professionals, equipment suppliers, and other resources that provide your care must accept assignment. This means they accept the Medicare-approved amount as full payment.
• In-network resources: If you have a Medicare Part C plan, you may be limited to using medical professionals, pharmacies, and facilities within a set network of approved resources. Contact your plan insurer to check your in-network options.
• Personal condition: Medicare will cover home healthcare only if a doctor certifies that:
  • It is difficult for you to leave your home without mobility aids or help from another person.
  • It isn’t recommended that you leave your home due to your condition.
  • You usually can’t leave your home due to the effort required.

You can find a Medicare-approved home health agency using Medicare’s online search tool.

Learn more about Medicare’s parts and what they cover.

To use your home healthcare coverage from Medicare, you will need to be up to date with your usual premiums and deductibles.

For all home healthcare apart from DME, you will not need to pay coinsurance or a copayment if you meet Medicare’s criteria for coverage.

For DME, you typically need to pay 20% of the equipment or supply’s cost as coinsurance.

The home health agency providing your care should tell you, verbally and in writing, how much Medicare will cover and what remaining costs you need to pay. This notice is known as an Advance Beneficiary Notice (ABN). If you don’t receive an ABN, make sure to check with the agency before getting your care.

If you have a Part A or Part B plan and have questions, you can contact Medicare directly.

To check your costs and coverage with a Medicare Part C plan, contact your plan insurer.

Learn more about how much Medicare costs out of pocket.

Medicare Part A helps cover home healthcare such as skilled nursing care, rehabilitation therapies, and home aide care. Medicare Part B also helps cover durable medical equipment and supplies.

If you have a Medicare Part C (Advantage) plan, it can also help cover the same care as parts A and B.

However, you may need to pay some money out of pocket for your care. You will also need to meet certain criteria for your care to be covered, such as using a Medicare-approved home health agency.

Contact Medicare or your Part C insurer if you have questions about your home health coverage or costs.