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Does Medicare Pay for Caregivers?

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:

  • The patient must be under the care of a doctor, and they must be receiving services under a plan of care that has been established and reviewed regularly by a doctor
  • The patient must require – and a doctor must certify that the patient needs – one or more of the following items:
  • Intermittent skilled nursing care (other than just drawing blood)
  • Physical therapy, speech-language pathology, or continued occupational therapy services. (These services are covered only when the services are specific, safe and an effective treatment for the individual’s condition. The amount, frequency, and the time period of the services needs to be reasonable, and they need to be complex or only qualified therapists can do them safely and effectively. In order to be eligible, either: 1) the patient’s condition must be expected to improve in a reasonable and generally predictable time period, or 2) the patient needs a skilled therapist to safely and effectively make a maintenance program for his or her condition, or 3) the patient needs a skilled therapist to safely and effectively do maintenance therapy for the patient’s condition.
  • The home health care agency that is caring for the patient must be certified by Medicare
  • The patient must be considered homebound, and this must be certified by a doctor as such

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:

  • 24-hour-a-day care at home
  • Meals delivered to your home
  • Homemaker services
  • Personal care

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.

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