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In-Home Care Services | Home Health Coverage (2022)

Your 1+1 Team
November 4, 2022

If your loved one faces health concerns and can longer be independent, they may benefit from receiving in-home care services. However, in-home care and other health services can be expensive, and some people typically seek help from Medicare to cover the costs. Medicare.gov provides information below on what home health services they cover and how you can qualify:

Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance) cover the following home health services:

  • Part-time skilled nursing care
  • Durable medical equipment
  • Medical supplies for use at home
  • Speech-language pathology services
  • Medical social services
  • Physical therapy
  • Occupational therapy
  • Part-time home health aide care ( only applies if you’re also getting other services such as nursing or therapy)
  • Injectable osteoporosis drugs for women

A home health agency can arrange the services per doctor’s orders, however, they must be Medicare-certified.

Medicare doesn’t pay for:

  • 24-hour care at home
  • Meal deliveries to home
  • Homemaker services (shopping, laundry, and cleaning) that aren’t connected to the care plan
  • Personal care and assistance with activities of daily living (bathing, dressing, or toileting) when it’s the only care you require

Who’s eligible

Your loved one with Part A and/or Part B is covered by Medicare’s home health benefit if they meet all of these conditions:

  • You must receive services regularly under a plan created and reviewed by a doctor.
  • A doctor must confirm that you are homebound (you can’t leave your house without help).
  • A doctor must confirm that you need one or more of the following:
    • Intermittent skilled nursing care (not including drawing blood)
    • Physical therapy, speech-language pathology, or continued occupational therapy services.
      • To be eligible, either 1) your condition is expected to improve in a reasonable or predictable amount of time, 2)you have a professional therapist to make an effective, safe maintenance program for your condition, or 3) you have a professional therapist who safely and effectively does maintenance therapy for your condition.

Some factors to consider:

  • You’re not qualified for the home health benefit if you need more than part-time or “intermittent” professional nursing care.
  • You may leave home for medical treatment and take short absences for non-medical reasons.
  • You can still receive home health care if you go to adult day care.

Costs in Original Medicare

  • Free of charge for covered home health care services
  • After you reach the Part B deductible, you need to pay 20% of the Medicare-Approved amount for medicare-covered medical equipment. Medicare pays for part of it and you’re expected to pay the difference.

Before you proceed with your home health care, the home health agency should confirm how much Medicare will pay. Specifically, the agency should inform you of any items or services they offer you that aren’t covered by Medicare, and the expected costs. This should both be spoken and in writing. The home health agency should also give you an Advance Beneficiary Notice (ABN) before proceeding with services and supplies that Medicare doesn’t cover.

To find out how much your loved one’s test, item, or service will cost, ask their doctor or health care provider. The amount you owe can depend on:

  • Other insurance you have
  • How much your doctor charges
  • If your doctor accepts the assignment
  • The type of facility
  • Where you get your test, item, or service

Make sure to ask questions, so you understand why your doctor or health care provider is recommending particular services, and if, or how much, Medicare will cover the costs.

1+1 Cares is a referral agency that works for clients and caregivers. We match caregivers with clients and inform them of your requirements. We work for you so you and your loved one can have a safe, enjoyable caregiving experience. Get In-Home Care Care!

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