Medicare Coverage of In-Home Care
What It Is
Medical and some personal care delivered in a patient's home
Medicare Part A covers part-time skilled nursing or rehabilitation care at home following a patient's hospital stay of at least three days. Medicare Part B covers the same care with no hospital-stay requirement. The care can include skilled nursing care and physical and speech therapy, as needed, along with medical supplies and equipment. Coverage can also include limited visits by a home health aide to help with personal care needs, as well as an occupational therapist to help the patient learn how to safely accomplish daily personal care. Medicare home care coverage is available only while a patient is actually recovering from an illness, condition, or injury. Once the patient's condition has stabilized, Medicare home care coverage ends. Medicare doesn't cover care needed because of a long-term condition or general frailty, and Medicare doesn't cover full-time or daily care.
Medicare Part A or Part B home care coverage is available only under several conditions:
The patient must need, and a doctor must prescribe, part-time skilled nursing care or rehabilitative physical or speech therapy to help the patient recover from an illness, injury, or acute condition.
At-home care is available only if a patient is "confined to home" (though not necessarily bedridden). This means unable to leave home without difficulty and without the help of another person or a medical device such as a wheelchair.
Home care must be provided by a Medicare-certified home healthcare agency. There is no specific limit on how many home care visits Medicare will cover. The home care agency and Medicare regularly evaluate a patient's condition and needs to determine how long the care is medically needed and thus how long Medicare will continue coverage.
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 in-home care, contact the plan directly.
What Medicare Pays
Medicare Part A or Part B pays the full amount of the home care agency's Medicare-approved charges, except for the rental cost of durable medical equipment such as a wheelchair or hospital bed, for which Medicare pays 80 percent.
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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