Do Medicare Advantage Plans Cover Home Health Care?

Medicare Advantage plans cover home health care. These plans, which you purchase through private health insurance companies, provide an alternative to Original Medicare and feature the same home health care coverage. However, you must meet certain eligibility requirements to qualify for services. 

Home health care includes a range of health care services you may receive in your home or a residential community setting following a significant injury or illness. This option often gives you access to the same types of services you may get in a hospital or skilled nursing facility, but it’s generally more cost-effective and convenient. Depending on your needs, some services you may obtain include:

 

• Medication administration
• Catheter care
• Wound care
• Pain management
• Management and monitoring of ongoing health conditions
• Feeding tube maintenance
• Speech, occupational and physical therapies
• Injections
• Health-related education
• Nonemergency medical transportation

Home health care agencies employ care staff who have professional training and hold relevant certifications and licenses to provide specialized care. Your home health care team may include aides, nurses, certified nursing assistants and rehabilitation therapists.

Like Original Medicare, which covers home health care services under Part A and/or Part B, Medicare Advantage plans pay for these services for qualified individuals. 

To qualify for services, you must:

 

• Need part-time or intermittent care
• Be homebound, meaning:
  • You have trouble leaving home without mobility assistance due to an injury or illness
  • Your current health makes it challenging to leave home
  • Leaving your home is inadvisable because of your health condition

To assess and certify your need for home health care services, your health care provider must have an in-person meeting with you. At this time, they may order home health care services and direct you to a list of local agencies that provide necessary services.

Under Original Medicare, beneficiaries get 100% coverage for home health care services and 80% coverage for durable medical equipment. However, Medicare stipulates that care must be provided for eight hours per day for a maximum of 28 hours per week or fewer than eight hours daily for up to 35 hours of care per week for no more than 21 days. There may be some leeway with this if your doctor can project how long you'll need skilled care at home.

While some Medicare Advantage plans may provide coverage beyond Original Medicare’s limits, policyholders generally don’t get coverage for 24-hour care or long-term services. If you want long-term home health care services, you may need to consider alternative ways to pay for care, such as long-term care insurance, life insurance benefits, reverse mortgages or Medicaid.