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What Medicare Home Health Care Covers (and What It Doesn't)

Posted on December 14th, 2015

Home health care encompasses multiple services provided in the home to an individual for treatment of an injury, illness, etc. On average, home health care expenses are less than treatment or services provided at a hospital, rehabilitation center or skilled nursing facility. For example, Johns Hopkins Schools of Medicine and Public Health conducted a Home Hospital pilot study that showed costs were reduced by as much as 60% for home-based patients despite comparable clinical outcomes for hospital-bound patients. Home health care also is more convenient for seniors with limited mobility who would otherwise be faced with a disruptive, emotionally taxing move to an elder care facility.

Home Health Care and Medicare Coverage

Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) don't pay for all home health care services. According to Medicare.gov the official U.S. Government Site for Medicare, coverage includes eligible home services such as:
  • Physical therapy
  • Intermittent (part-time) skilled nursing care that must be ¬†less than 7 days a week or less than 8 hours daily over a 21 day (or less) period. Some exceptions will apply.
  • Speech/language pathology services
  • Continued occupational services
  • Medical supplies such as wound dressings when ordered with your care program
  • Medical social services

Eligibility for home health services covered by Medicare is explained in greater detail on their website.  

Services Medicare Does Not Cover

The official Medicare and Home Health Care booklet for individuals with Original Medicare lists the following examples of what Medicare does not pay:

  • 24-hour daily in-home care
  • Meals delivered to your home
  • Domestic services such as cleaning, laundry and shopping when these are the only home health care services needed and these particular services are not related to your care plan
  • Personal care such as bathing, dressing and bathroom assistance given by home health aides when this is the only care needed

It's extremely important to talk with your personal physician and/or home health care agency regarding your care plan and any questions you have regarding which services will be covered by Medicare. You also can call 1-800-MEDICARE (1-800-633-4227.)

Note: Tell your doctor or health care provider if you have a Medicare Supplement Insurance or Medigap policy in order to ensure correct payment for all services.

When weighing the cost of walk-in tubs for an accessible bathroom for a senior with limited mobility, it's best to speak with your doctor, home health care agency and supplemental insurance provider to determine the best course of action. An ADA handicap bathroom can mean the difference between having to move to an assisted living facility and being able to stay in your own home while recovering from an injury or learning to adapt to limited mobility due to illness or a medical condition.

Medicare coverage is subject to change, stay current with your options by dialing 1-800-MEDICARE or visiting Medicare.gov.

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