Medicare only covers limited home health care services under Part A. For those who are in a Medicare Advantage plan, there may be different rules, but the plan must provide at least the same coverage as Original Medicare (Part A and Part B). Some services, however, may only be covered in certain settings or for patients with certain conditions.
In general, Medicare Part A covers home health services such as intermittent skilled nursing care, physical therapy, speech-language pathology services, continued occupational services, and certain other services. Typically, a home health care agency will coordinate the services that your doctor orders for you.
How to Qualify
All people with Medicare Part A and / or Medicare Part B, and who meet all of the following conditions are covered:
What Are the Potential Costs?
If the patient has Original Medicare, the cost will be $0 for home health care services. However, the enrollee will be charged 20 percent of the Medicare-approved amount for any durable medical equipment (DME) that is purchased.
Prior to obtaining any home health care, the home health care agency should inform the patient of how much Medicare will pay. The agency should also inform the patient of any items or services that they provide that will not be covered by Medicare, as well as how much the patient will have to pay for these items.
It is important to note that Medicare will not pay for the following services:
In order to get a better determination of how much a specific test, item, or service will cost, talk with your doctor or other health care provider. The amount that you will owe can depend on many different factors, such as any other insurance that you may have, how much your doctor will charge, whether or not your doctor accepts Medicare assignment, and / or the location where you obtain your test, item, or service.