.png&w=256&q=75){kind=small}
What Are the Limitations of Medicare Coverage for Home Health Care?
Date Updated: December 13, 2024
Written by:
Lauren Thomas is a seasoned writer that specializes in long-term care, with a special focus on dementia-related topics. She holds a degree in counseling and uses her knowledge and experience to create insightful content that gives seniors and families the information they need to make important care decisions.
Reviewed by:
Dr. Brindusa Vanta is a health care professional, researcher, and an experienced medical writer (2000+ articles published online and several medical ebooks). She received her MD degree from “Iuliu Hatieganu” University of Medicine, Romania, and her HD diploma from OCHM – Toronto, Canada.
The limitations of Medicare coverage for home health care include the types of services that qualify for coverage and the length of time you obtain care. Home health care is appropriate for those who need short-term or intermittent skilled nursing services following a significant injury or illness, and it often allows individuals to avoid or shorten the duration of care in a nursing home or skilled nursing facility.
Medicare Coverage for Home Health Care
Medicare pays for medically necessary skilled nursing services individuals receive at home as an alternative to a hospital or skilled nursing facility. For an individual to receive coverage for services, they must be under a doctor's care and receive home health care services as part of their care plan. Additionally, they must be homebound and obtain services from a Medicare-certified home health care agency.
Through home health care, seniors can receive many services they would otherwise get in a hospital or skilled nursing facility. This may include:
- Diabetes management
- Disease monitoring and management
- Catheter care
- Feeding tube maintenance
- Nutrition counseling
- Speech, occupational and physical therapies
- Medication administration
- Vitals monitoring
- Medical social services
- Wound care
- Administration of certain IV drugs
When Does Medicare Not Cover Home Health Care?
Medicare doesn’t pay for home health care services in all circumstances. If you need more than short-term or intermittent care, which Medicare defines as fewer than eight hours of daily care for no more than 28 hours per week and 21 days per 30-day period, you may not qualify for coverage. While there is some leeway with these figures, depending on how long your doctor expects you to need services, Medicare typically doesn’t cover care at home indefinitely. Along with this, the care you receive must be medically necessary. Your doctor may recommend certain home health care services, such as physical or occupational therapy, but if it’s not medically necessary, you must make other payment arrangements.
Additionally, Medicare doesn’t pay for nonmedical custodial services unrelated to the condition you’re treating. If your care needs are limited to services such as assistance with personal care, meal services, household chores or transportation, Medicare doesn’t provide coverage.
How to Pay for Home Health Care Services
Along with Medicare, you have several options for paying for home care. Long-term care insurance and Medicaid waivers can help you pay for services that fall outside of the scope of Medicare’s coverage. Alternatively, reverse mortgages, annuities, collective sibling agreements or life insurance benefits can provide the funds you need to obtain services at home.