Medicare Coverage of Medical Social Services
What It Is
Medical social services, including assistance with arranging care and coverage
Neither Medicare Part A nor Medicare Part B covers the services of a medical social services provider except in the limited circumstances described below:
For a hospital or skilled-nursing-facility inpatient, Medicare Part A covers the services of a discharge planner or social services provider who can assist with post-discharge care arrangements.
For outpatients, Medicare Part B covers medical social services only as part of covered, comprehensive in-home healthcare provided by a Medicare-certified home healthcare agency.
If you have a Medicare Part C Medicare Advantage plan: Medicare Part C Medicare Advantage plans, also called Medicare Advantage plans, must cover everything that's included in original Medicare Part A and Part B coverage. But sometimes a Part C plan covers more, with extra services or an expanded amount of coverage. (Co-payments for Part C plans may also be different than those for Part A or Part B.) To find out whether your plan provides extra coverage or requires different co-payments for medical social services, contact the plan directly.
What Medicare Pays
Medicare pays nothing for medical social services as a separate category of care.
The services of a hospital or nursing-facility discharge planner or medical social services provider are covered by Medicare Part A as part of total facility charges.
Medical social services provided by a home healthcare agency as part of comprehensive in-home care are covered by Medicare Part B as part of the total in-home care agency charges.
Important: Regardless of the rules regarding any particular type of care, in order for Medicare Part A, Medicare Part B, or a Medicare Part C plan to provide coverage, the care must meet two basic requirements:
The care must be "medically necessary." This means that it must be ordered or prescribed by a licensed physician or other authorized medical provider, and that Medicare (or a Medicare Part C plan) agrees that the care is necessary and proper. For help getting your care covered, see FAQ: How Can I Increase the Odds That Medicare Will Cover My Medical Service?
The care must be performed or delivered by a healthcare provider who participates in Medicare.
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