Which Medicare Advantage Plans Cover Home Health Care?
Date Updated: December 20, 2024
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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.
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All Medicare Advantage Plans cover home health care. These plans, also called Medicare Part C, provide an alternative to Original Medicare and, at minimum, cover the same scope of services. For full details on what your Medicare Advantage plan covers, talk to your health insurance provider.
What Is Medicare Advantage?
Medicare Advantage provides an alternate way to get Medicare Parts A and B coverage. While the federal government administers Original Medicare, private health insurance companies offer Medicare Advantage plans. These plans contain almost all Original Medicare benefits, with a few exceptions, such as hospice care and certain costs associated with clinical trials, and they provide policyholders with the same rights and protections they'd have under Original Medicare.
Several types of Medicare Advantage plans exist, including:
- Health Maintenance Organization plans
- Preferred Provider Organization plans
- Private Fee-for-Service plans
- Special Needs plans
- Medical Savings Account plans
In many cases, Medicare Advantage plans include benefits beyond the scope of Original Medicare, such as prescription drug coverage, vision and dental coverage, and health club memberships. Additionally, Medicare Advantage policies may include maximum out-of-pocket limits or benefits such as $0 deductibles, providing financial incentives for policyholders.
Does Medicare Advantage Pay for Home Health Care?
Like Original Medicare, Medicare Advantage plans cover home health care services for those who need part-time or intermittent skilled nursing at home or in a residential community setting. The services you receive depend on your unique needs and may include:
- Monitoring unstable health status
- Tracking blood pressure, temperature and heart rate
- Physical, speech and occupational therapies
- Medication administration, including injections
- Intravenous or nutrition therapy
- Wound care
- Help with medical equipment
By Medicare’s definition, “part-time or intermittent” skilled nursing means the individual needs skilled nursing services at home up to eight hours per day for a maximum of 28 hours per week. Alternatively, a person may be able to get more frequent care for less time per day, such as less than eight hours per day for up to 35 hours per week, if their doctor believes it’s appropriate.
How Do I Get Medicare Advantage to Pay for Home Health Care?
For you to access home health care coverage under Medicare Advantage, your doctor must order specific skilled nursing services and provide you with a list of approved home health care providers. Once you choose a home health care agency, the agency schedules someone to visit your home to discuss your needs and conduct a health assessment.
Before services begin, the home health care agency should tell you how much your plan will pay and whether any items or services you need fall outside your coverage. In several states, including Florida, Illinois, North Carolina, Ohio and Texas, the agency must submit a request for pre-claim review of coverage to Medicare, helping you know exactly what coverage you'll receive.