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Medicare generally covers home health care services, including home health aides and certain therapies. To qualify for coverage, though, you'll have to meet certain requirements. And for some services, you'll be responsible for part of the cost.
Which home health care services are covered by Medicare?
Skilled nursing (part-time, intermittent only).
Home health aides (part-time, intermittent only).
Medical social services.
Speech-language pathology services.
Injectable osteoporosis medicines for women.
Durable medical equipment and medical supplies for home use.
These services are also covered by Medicare Advantage plans, which are offered by private insurers that contract with the federal government, though additional network restrictions may apply.
The following services generally aren't covered:
24-hour home care.
Personal/custodial care such as dressing, bathing or toilet assistance (if this is the only type of care you need).
Domestic services like cleaning, laundry or shopping (if this is the only type of help you need).
What are the costs?
Original Medicare covers eligible home health care services at no cost to you if you meet certain requirements. But for other services, you'll have to share the costs:
Physical therapy, occupational therapy or speech-language pathology: You pay 20% of the Medicare-approved costs.
Eligible durable medical equipment (wheelchairs, walkers, crutches, etc.): You pay 20% of the costs.
In both cases, your Part B deductible also applies if you haven't yet met it.
A larger portion of that coinsurance may be covered if you have a Medigap policy, which provides supplemental coverage to Original Medicare. With a Medicare Advantage plan, additional restrictions and costs may apply.
Home health services costs can vary dramatically depending on where you live. The national average cost of hiring a health aide was $20.50 per hour in 2016, the most recent data available, according to the U.S. Department of Health and Human Services.
Eligibility requirements for home health care coverage
To be eligible for home health services under Original Medicare, you need to meet certain conditions:
You must be under the care of a doctor. The plan of care you follow should also be established and regularly reviewed by a doctor.
Your doctor must certify that you’re homebound. This doesn’t mean you aren’t ever able to leave home — just that it’s very difficult for you to do so, or that you need special equipment or help to go out. You won’t lose eligibility for coverage if you venture out occasionally and briefly for doctor’s appointments or even non-medical activities like religious services, a short walk or drive, weddings, graduations, funerals or family events.
Your doctor must certify that you actually need home services. To be covered, your doctor must draw up a care plan that includes the necessary services. For physical therapy, speech-language pathology or continued occupational therapy services, the services must be deemed specific, safe and effective treatments for your condition and must be provided by a Medicare-certified home health agency.
The home health agency you're working with should tell you how much will be covered by Medicare before you start receiving services.
When to enroll
If you're eligible for Medicare when you turn 65, you can enroll for it in the seven-month period starting three months before your 65th birthday. This is called the initial enrollment period.
For those already receiving Social Security or Railroad Retirement Board benefits, enrollment in Medicare Parts A and B is automatic on the first day of the month you turn 65.
Outside of the initial enrollment period, you can also sign up or change plans during certain designated enrollment periods.