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Will Medicare Pay for In Home Care?

There are some instances where Medicare will pay for in home care. Medicare Part A (Hospital Insurance) and / or Medicare Part B (Medicare Insurance) will cover eligible home health care services such as intermittent skilled nursing care, physical therapy, speech-language pathology services, continued occupational services, and other related services. Typically, a home health care agency will coordinate the services that your doctor has ordered for you.

There are certain services that are related to in home care that Medicare will not pay for. These include the following:

  • 24-hour-per-day care at home
  • Meals that are delivered to your home
  • Homemaker services
  • Personal care

Who is Eligible for In Home Care Coverage Through Medicare?

Those who have Medicare Part A and / or Medicare Part B and who also meet the following conditions may be eligible for in home care coverage:

  • You are under a doctor’s care, and you are receiving services under a particular plan of care that has been established – and is being regularly reviewed – by a doctor.
  • You require – and a doctor must certify that you require – at least one or more of the following:
  • Intermittent skilled nursing care (other than just having blood drawn)
  • Physical therapy, speech-language pathology, or continued occupational therapy services (with some limitations). In order to be eligible, your condition must be expected to improve within a reasonable and generally predictable period of time, or you need a skilled therapist to safely and effectively make a maintenance program for your condition, or you require a skilled therapist to safely and effectively do maintenance therapy for your condition. The amount, frequency, and time period of the services that you require must be reasonable, and they must be complex or only qualified therapists can do them safely and effectively.
  • The home health care agency that is providing care to you must be certified by Medicare.
  • You are homebound (and it is certified by a doctor that you are homebound).

In some instances, the home health care services that are received may also include medical social services, part-time intermittent home health aide services, medical supplies for use at home, durable medical equipment, and / or injectble osteoporosis drugs.

How Much Does In Home Care Cost?

In most cases, you will not be required to pay for Medicare-covered in home care. However, there may be a 20% co-payment of the Medicare-approved amount for any durable medical equipment that you require.

In order to obtain a more accurate determination regarding any type of in home care that will be received, the home health care agency that will be providing such care should inform you of how much Medicare will pay.

The agency should also inform you whether there will be any items and / or services that will not be covered by Medicare, as well as how much these items will cost. This information should be provided to you in writing in a document titled the “Home Health Advance Beneficiary Notice.”

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