Insurance information
Medicare is the nation’s largest health insurance program, offering coverage to people over the age of 65, or to those under 65 who have been totally and permanently disabled for at least ten years.
If you are over 65 or covered under Medicare benefits, home care services may be available at no cost to you. Medicare pays for home health services deemed reasonable and necessary for treatment of your diagnosis or condition.
Your home health agency must tell you in advance what Medicare will cover. They must also inform you (verbally and in writing) of any services that are not covered and what they cost.
If you have supplemental insurance, you may be able to receive other services in addition to those covered by Medicare.
How much of home health is covered by Medicare?
Medicare pays for home health services deemed reasonable and necessary for treatment of your diagnosis or condition, including:
- Skilled nursing care
- Physical and/or speech therapy
- Occupational therapy, medical social services, and/or home health aide services (in conjunction with skilled nursing, physical therapy or speech therapy at the beginning of care)
What is required for coverage?
To qualify for Medicare home health coverage, you must meet all of the following conditions:
- Your care is being provided by a Medicare certified home health agency.
- Your plan of care has been established and is being reviewed by your physician at least every 60 days.
- You are homebound (generally unable to leave home to obtain the care you need). This can be a long-term or temporary condition.
- You are receiving care in your place of residence, including assisted living facilities.
- You require services on an intermittent basis for up to 60 days or longer if your physician recertifies and you still meet criteria.
- The care is medically necessary to treat a disease or injury.
What doesn’t Medicare cover?
Medicare pays for home health services deemed reasonable and necessary for treatment of your diagnosis or condition, including:
- Skilled nursing care
- Physical and/or speech therapy
- Occupational therapy, medical social services, and/or home health aide services (in conjunction with skilled nursing, physical therapy or speech therapy at the beginning of care)
What doesn’t Medicare cover?
There are a number of medical services that are not covered by Medicare, including:
- 24-hour care at home
- Meals delivered to the home
- Homemaker services (cleaning, shopping, laundry, etc.)
- Personal care (such as bathing) from home health aides if this is the only care needed
These services are generally provided through personal home care assistance services or covered through private pay insurance.
A plan in two parts
Medicare is made up of two components. Part A, which is usually available at no cost to you, helps pay for inpatient hospital care as well as home healthcare. Part B, which usually requires a monthly premium, helps pay for doctor’s services, outpatient hospital care, some medical services and home healthcare.
Part A at a glance:
- You are eligible for Part A when you turn 65 if you or your spouse has paid in enough quarters while working.
- If you did not pay Medicare taxes, you may be able to buy Part A.
Part B at a glance:
- You can purchase Part B when you turn 65.
- You or another payer, such as Medicaid, pay a monthly premium.
- Part B also covers home health.
- Part B covers outpatient hospital visits and some medical services that Part A does not.
