Some seniors may be concerned about whether or not Medicare will pay for home health care expenses. There is a wide range of home health care services, from physical therapy to hospice care for the terminally ill, and all of them come with hefty price tags.

The National Health Expenditure Accounts (NHEA)[1] estimate that by 2020, Americans will have spent more than $123 billion on home health services. Medicare benefits can help pay for in-home care for you or a loved one, which is crucial as medical costs continue to rise.

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Home Health Care

Contrast this with home care, which refers to services provided in a person's home and often includes help with basic tasks like bathing and dressing (ADLs).

Most patients who get home health care services have serious health problem that requires immediate attention. According to Medicare.gov, the objective is to improve the patient's health to the point that they can resume their previous level of independence and, if that is not possible, to help them become as self-sufficient as possible through managing their symptoms.

Does Medicare cover Home Health Care?

According to Ari Parker, co-founder and chief adviser at Chapter, an independent Medicare advisor organization, home health care is covered by Medicare Parts A and B if the services requested are reasonable and necessary for the person's unique condition or injury. Medicare home health care eligibility also requires a physician's declaration of homebound status.

Physical therapy, occupational therapy, and speech-language pathology services are all covered by Medicare. Parker also notes that Medicare pays for "Medicare social services," which includes "counselling to help with social and emotional difficulties that could impair the rehabilitation process," if prescribed by a doctor.

Medicare will pay for skilled nursing, physical therapy, occupational therapy, and other approved home health care services on an intermittent or as-needed basis. Still, the program becomes less useful when the amount of care provided is more custodial or constant.

Chris Orestis, the president of Retirement Genius and a Certified Senior Advisor, adds that Medicare will not pay for round-the-clock care, meal delivery, or home care services like cleaning, laundry, or assistance with ADLs like bathing, toileting, or dressing.

How does Medicare pay for home health care?

Parker explains that if you have Original Medicare, you'll need to use Part A and Part B to pay for your share of home health care costs.

Caregiver assistance programs and accessibility renovations are two examples of the supplementary services included in some Medicare Advantage plans. However, Parker notes that it is crucial to understand the coverage offered before enrolling in a Medicare Advantage plan because the benefits of home health care vary greatly from plan to plan.

When Does Medicare Cover Home Health Care?

According to Medicare expert Lindsay Malzone of Medigap.com, a patient must first meet Medicare's requirements for home health care to be considered medically necessary before receiving such services. Malzone states the following requirements must be completed to be eligible for Medicare-funded home health care:

What Kinds of Health Care at Home Does Medicare Pay For? According to Orestis, the following types of home health care are covered by Medicare Part A (hospital insurance) and Medicare Part B (medical insurance):

How Much Does Home Health Care Cost?

When looking for full-time care, the expense of home health assistance can be prohibitive. According to the most recent Genworth Cost of Care survey, full-time care from a home health assistant is estimated to cost $5,148 per month[2]. You may not have to pay anything out of pocket for less intensive services like those mentioned above if they fall under Medicare's coverage and your doctor orders them. Home health care costs can be estimated by looking at the average hourly rate for home health care in your state.

It's not true that Medicare doesn't cover any home health services, but many of them aren't. Medicare's ability to assist you in meeting these costs will vary from person to person based on several criteria, including the specific services you require and the length of time you will require them. Most Medicare plans pay for standard home health care that focuses on getting you back on your feet and helping you maintain your daily activities. If you have particular questions about your home health care services coverage, you should speak with your plan administrator.