Home health care covered by Medicare
Home health care (a wide range of health and social services provided in the home) is necessary for older adults and people with disabilities who have limited mobility. Medicare covers home health care when certain requirements are met:
- You are isolating at home, which means you have difficulty leaving your home and need help.
- You need intermittent skilled nursing or therapy services. This is care provided by or under the supervision of skilled professionals and includes physical, speech and occupational therapy. These services must occur at least every 60 days and at most daily for three weeks.
- You meet with your doctor in person (in the office or hospital, or by video) within 90 days before starting care or within 30 days of your first day of care.
- Your doctor signs a certificate confirming your eligibility and need for home health care and confirming that they have approved your plan of care.
- You get care from a Medicare-certified home health agency (HHA).
In these cases, Medicare-covered home health care is available. Most home health care is covered by Part B, but in some cases, Part A may also cover home health care after a qualifying three-day hospital stay or stay in a covered skilled nursing facility (SNF). Medicare Advantage beneficiaries may have different rules for obtaining coverage and additional costs in the form of copayments, and they may have to use their plan's network of home health care providers.
Medicare only covers certain home services. Skilled nursing care, skilled therapy services, home health aides, medical social services, certain medical supplies and durable medical equipment (DME) can be overridden Under home health care benefits. Services not covered include: 24-hour nursing care, prescription drug coverage (although Part D coverage still applies to those who get home health care services), meal delivery, and custodial care (such as laundry or meal preparation), unless these services are provided as part of a skilled nursing or therapy visit.
Medicare Home Health Care is not Medicaid HCBS
Despite the similar name, Medicare home health care benefits are different from Medicaid's home and community-based services (HCBS) coverage. Eligibility and benefits for the two programs are not the same.
Medicare's home health care coverage generally does not include long-term care.
Medicare home health care covers skilled nursing and therapeutic care, excluding custodial and around-the-clock care unless the individual is receiving hospice care. Medicare coverage generally does not include long-term care: Home health care plans and certifications are valid for a limited period (60 days) and can be renewed by a doctor for an additional 60 days as needed. Medicaid HCBS, on the other hand, is a long-term care benefit funded by state-level Medicaid waiver programs. Depending on state regulations, Medicaid beneficiaries and dual-eligible Medicare-Medicaid beneficiaries may be able to obtain HCBS.
Advocate for expansion
Currently, Medicare coverage for home health care is very limited and does not meet the full needs of many seniors and people with disabilities. Many gaps remain for stronger and more comprehensive home health care coverage, leaving people with unaffordable and inadequate options and leading to expensive nursing home admissions, even when people would prefer to stay in their homes. Recent surveys have found that demand for home care is high and most states have long waiting lists for Medicaid HCBS.
Medicare coverage for home health care is very limited and does not meet the full needs of many seniors and people with disabilities.
Even with insurance, finding and obtaining home health care can be a challenge. Home health care completion rates decreased among Medicare beneficiaries whose physicians recommended home care after hospitalization. The number of home health agencies (HHAs) has continued to decline since 2013, and research shows that economically disadvantaged areas have more limited access to home health resources and Medicare-covered home health providers.
Improving access to home health care under Medicare can promote equity and reduce barriers to care where Medicaid is limited by state policy differences and restrictive income limits. Expanding home health benefits not only supports Medicare beneficiaries, but also their families, caregivers and communities.
Medicare Rights supports previous efforts to expand Medicare home health care benefits, and we know that the freedom to age in place in your own community is important to many people with Medicare. We will continue to advocate for health insurance policies that expand home health care and ensure fairness and dignity for seniors and people with disabilities.
