What to Know About Medicare and Home Health Aides Coverage

• Medicare covers home health aides as part of the Medicare home health benefit on an intermittent basis. A Medicare beneficiary must meet certain criteria in order for Medicare to cover home health services. 

• If a Medicare beneficiary is eligible for home health aide services, they will need to schedule care through a home health care agency, which is usually provided by the beneficiary’s doctor. The home health agencies must be Medicare-approved in order to be covered. 

• Medicare Advantage plans, Medigap policies, and Dual Eligibles will also cover home health care, though different rules and costs may be in place.

There are instances in which an illness or injury requires in-home care administered by a home health aide such as a licensed practical nurse. But does Medicare cover home health services and the healthcare professionals who practice it?

In short, yes, Medicare covers home health services so long as a Medicare beneficiary and the care itself meets specific criteria. For example, the health care provider must be needed to administer skilled care. They cannot simply be for shopping, personal care, or other such services. There must be a medical necessity in order for home health care and home care providers to qualify as Medicare benefits. 

This article will explain how Medicare and home health aides coverage works.

Home health services, also known as home health care, encompass a variety of services that can be administered from the patient’s home for an injury or illness. Home health care is more convenient and less expensive than receiving the same treatments from the hospital or a skilled nursing facility (SNF).

Home health benefits include: 

• Helps regain patient independence

• Bolsters patient’s self-sufficiency

• Aides recovery

• Slows disease progression

Note: Learn more about home health services at this resource.

Original Medicare consists of Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). Part A covers inpatient health services while Part B covers outpatient health services.

Medicare pays for a number of home health care services. That said, certain requirements must be met in order for Medicare to cover home healthcare services including the provider type, duration of care, and more. Learn more about this below.

Types of Providers

There are different types of home health providers but not all are covered by Medicare.

• Home Health Aides: A home health aide is a type of caregiver that provides various personal care services as well as medical care from the comfort of a patient’s own home. There are various types of home health aides including registered nurses, licensed practical nurses, and physical therapists. Home health aides are covered by Medicare so long as certain criteria are met. 

• Other home care workers: Not all home care workers are home health aides and vice versa. Examples of home care workers that are not home health aides include companions and/​or homemakers, personal care aides, and certified nursing assistants. These types of home care aides are not covered by Medicare.

Eligibility Requirements

In order to receive home health services that are covered by Medicare, the following criteria must be met: 

• The patient is eligible 

• The treatments are considered to be reasonable and necessary 

In order for a patient to be eligible for home healthcare, the following must be true: 

• The patient’s doctor is involved in the process

• The patient’s doctor verifies that one (or more) of the following services are needed: 

  • Intermittent skilled nursing care (other than drawing blood)

  • Physical therapy

  • Speech-language pathology services

  • Continued occupational therapy

• The home health agency is Medicare-approved

• The Medicare beneficiary is homebound 

Note: Learn more about Medicare and home health services eligibility on page five of this resource.

Duration of Coverage

Medicare only covers intermittent home health care, not long-term home health care. Home health care must meet the following in order to be considered intermittent: 

• Fewer than seven days per week 

• Less than eight hours per day 

• Up to 21 days total for care 

Covered Services

Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) cover various eligible home health services such as:

• Skilled nursing services and care 
• Physical therapy
• Speech-language pathology services (i.e. speech therapy) 
• Medical social services
• Part-time or intermittent home health aide services (personal hands-on care)

Skilled nursing care is a rather broad term but includes services such as:

• Wound care

• Patient and caregiver education

• Intravenous or nutrition therapy

• Injections

• Monitoring serious illness and/​or unstable health status

Medicare will not cover: 

• 24-hour-a-day home care

• Meal delivery

• Homemaker services (shopping, cleaning, and laundry) when this is the only care needed

• Custodial or personal care (bathing, dressing, or using the bathroom) when this is the only needed care

Note: Learn more about Medicare coverage for home health services at this resource.

Home Health Costs and Medicare

Medicare beneficiaries pay nothing for home healthcare services. For durable medical equipment (DME), beneficiaries are expected to pay 20 percent of the Medicare-approved amount for the medical equipment needed such as hospital beds. Furthermore, Medicare will also fully cover the cost of medical supplies such as wound dressings, catheters, etc. when they’re provided by a Medicare-certified Home Health Agency (HHA).

An important note when it comes to costs: if a health care provider or HHA believes that certain providers, care regimens, supplies, etc. won’t be covered by Medicare, they are required to share an Advanced Beneficiary Notice of Non-Coverage (ABN). This notice will walk through each item or service they believe to not be covered so that you are aware of your options and cost estimates.

Note: Learn more about Medicare costs for home health services at this resource. For more information about ABNs, visit this source.

Medicare Advantage plans, also known as Medicare Part C or MA plans, are supplemental insurance plans contracted through private insurance companies that are Medicare-approved. MA plans bundle Medicare Part A (hospital insurance) and Medicare Part B together. Many Medicare Advantage plans also include prescription drug coverage.

Medicare Advantage plans must provide the same level of coverage as Original Medicare. However, different rules and costs may be involved. This will all depend on the specific Medicare Advantage plan chosen. Always check with the healthcare plan’s insurance company to confirm coverage. 

Medigap, also known as MedSupp, are Medicare supplement insurance plans that help ​“fill in the gaps” of Original Medicare. This means that a Medigap policy helps pay out-of-pocket expenses associated with an Original Medicare plan such as Part B deductibles and premiums, as well as other costs. This means Medigap could potentially help lower out-of-pocket costs for DME needed for home health care.

Some Americans are eligible for both Medicare and Medicaid, a program known as Dual Eligibles. Under the Dual Eligibles program, Medicare acts as the primary payer and Medicaid is secondary. Because Medicare pays first, this means home health services would be covered in the same manner as Original Medicare. That said, Medicaid may cover additional services not covered by Medicare. 

Note: Learn more about dual eligibility for Medicare and Medicaid and covered services at this resource.

What if a beneficiary requires long-term care?

Medicare only covers home health services on a short-term basis. As such, there may be concern about how to pay for home healthcare should the services be necessary on a long-term basis as beneficiaries are responsible for 100 percent of the healthcare costs associated with that level of care. If this is the case, there are options including enrolling in a Medigap policy, PACE, or long-term care insurance.

Note: Learn more about payment assistance for caregivers at this resource.

What makes a quality home health agency?

A quality home health agency is important to receiving quality care at home. Some signs to look out for include:

• Medicare-certified

• Offers required medical services (i.e. skilled nursing care, physical therapy, etc.)

• Meets special needs (language or cultural preferences)

Note: Learn more about selecting quality home health agencies at this resource. For more information about what an HHA is, visit this source. For information about how to apply and become an HHA, visit this source.

What are the patient rights when it comes to home health care?

Medicare beneficiaries have set guaranteed rights and protections. These rights and protections are enforced by federal law. Some such rights include choosing the home health agency for their care (within the plan network), having home property be treated with respect, and more.

Note: Learn more about Medicare patient rights for home health care at this resource.