When does Medicare cover home health services?
Medicare will cover a limited amount of home health care services as an alternative to entering a nursing home when certain criteria are met. A home health agency must be Medicare certified, and a doctor must make the decision whether or not home care is needed. Medicare does not cover custodial care (non-nursing personal care) unless it is needed in combination with skilled nursing care for the recovery or rehabilitation of a short-term illness.
What Does Medicare Cover?
- Skilled nursing care is care that must be performed by a licensed nurse and is only needed on a part time basis. Qualified nursing care may include wound care management, administration of intravenous (IV), medication management, injections, tube feeding, and oxygen to help with breathing,
- Skilled care includes nursing care plus rehabilitation therapies such as speech therapy, physical therapy, and occupational therapy for as long as the physician in charge has arranged it in the care plan. Care that can safely be performed by a non-medical person without the supervision of nurse is not considered skilled care.
- Home health aide services are only covered if the aide services are part of the care plan due to illness or injury and are only needed on a part-time intermittent basis. If home health aide services are the only service needed, they are not covered. Home health aide services may include activities of daily living such as dressing, using the bathroom, bathing, or other personal care. These non-nursing services are not provided by a licensed nurse.
- Medical social services are provided when they relate to the specific illness or injury that Medicare home health care covers. This might include counseling or help in finding community resources.
- Certain medical supplies and durable medical equipment are covered such as wound care products and wheelchairs or walkers.
Currently, Medicare does not cover any of the following:
- Homemaker/companion services such as shopping, cleaning, laundry, or errands.
- Home health care needed 24 hours per day.
- Meal preparation.
- Homemaker/companion services such as shopping, cleaning, and laundry.
- Assistance with personal care given by home health aides such as bathing, dressing, and toileting when this is the only care that is provided.