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What Are the Out-of-Pocket Costs for Medicare 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 out-of-pocket costs for Medicare home health care include 20% of the Medicare-approved cost of durable medical equipment. Medicare provides 100% coverage for home health care services for qualified individuals when they receive covered services. Additionally, it covers 80% of the Medicare-approved cost of equipment, such as hospital beds and mobility aids.
How Much Does Home Health Care Cost?
According to the 2024 Genworth Cost of Care Survey, the national median cost of home health care sits near $33 per hour, with a monthly projected expense of $6,292. Across the country, rates vary considerably based on factors such as the local cost of living and availability of services. For example, in Oregon, the monthly median cost of this type of care hovers near $5,053, while seniors in Maine can anticipate higher fees of around $8,008.
What Coverage Does Medicare Provide for Home Health Care?
Fortunately, Medicare provides coverage for home health care services under Parts A and B. This program pays for 100% of the qualifying home health care services you receive. Additionally, it pays for 80% of the cost of durable medical equipment, such as walkers and wheelchairs.
For Medicare to pay for home health care services, the doctor treating your condition must submit a written order stating that you have a medical need for skilled nursing services or DME. Additionally, the provider must deem you homebound, with leaving your home very difficult or unsafe due to the nature or extent of your injury and illness. You must also only need short-term or intermittent care, which Medicare defines as no more than eight hours of care per day and 35 hours per week for a maximum of 21 days in a 30-day period.
Does Medicare Cover Nonmedical Care at Home?
Medicare pays for nonmedical services you receive at home only if your care plan requires these services. However, it doesn’t pay for nonmedical care if you only need that type of care. In other words, if you don’t require skilled nursing services but need assistance with daily living activities, such as bathing, dressing or household chores, Medicare doesn’t pay for care. Alternatives to help pay for in-home care include Medicaid waivers, long-term care insurance, veteran’s benefits and life insurance benefits.