Will Medicare Pay For Home Health Care?

Home health care can be an invaluable asset after hospital stays for illness or injury, and is also often chosen as part of long-term rehabilitation from long-term conditions such as dementia or stroke.

Medicare does not cover 24-hour care, meal delivery or domestic services such as cleaning and shopping; however it can assist with home health aides and medical equipment if your doctor orders specific medically necessary home-based rehabilitative or nursing services, including walkers and wheelchairs. Furthermore, Medicare covers some durable medical equipment (typically up to 80% of its Medicare-approved amount for items like walkers and wheelchairs).

To qualify for Medicare home health care benefits, a plan of care must be established by and regularly reviewed with your physician. You must also be homebound (i.e. not be able to leave without considerable effort or an aid such as wheelchair or walker). Finally, Medicare pays for intermittent skilled nursing care as well as physical therapy, occupational therapy or speech-language pathology services as needed by your physician – plus medical supplies like dressings and catheters when ordered by them.

Home health care should always come from a Medicare-certified agency, according to AARP. Doing so ensures your provider follows Medicare guidelines properly while helping lower out-of-pocket costs as their home health aides understand its requirements and rules.

Medicare does not cover custodial care – which refers to non-skilled personal assistance like bathing, feeding and dressing – for individuals needing rehabilitation home health care at home. You may be able to find assistance through private or public programs like adult day care services or vouchers offered through state Medicaid programs.

If your doctor decides that home health care is unnecessary for you or you do not meet eligibility criteria for coverage, Medicare will notify you early through what’s called an Advance Beneficiary Notice of Noncoverage (ABN). If this decision doesn’t sit well with you, appeal procedures exist so you can challenge it.