To receive home healthcare under Medicare, specific conditions must be met. If you are suffering from an illness or injury that renders you “homebound,” you can qualify for home healthcare services. This coverage is provided by Medicare as long as certain requirements are fulfilled. To understand how to get Medicare’s home healthcare services, here’s a detailed breakdown.
Understanding Home Healthcare and Medicare
Medicare offers home healthcare services for those who are homebound due to illness or injury. To be eligible for these services, you must be officially enrolled in Medicare, which covers a wide array of medically necessary home health services. Services include physical therapy, skilled nursing care, and help with managing chronic illnesses that are deemed medically necessary.
However, Medicare will not pay for non-medical services. For instance, help with daily household chores such as shopping, cleaning, or meal preparation is not covered unless these tasks are related to your care plan.
For further details, visit Medicare’s official home health page.
How to Qualify for Home Healthcare
What does it mean to be “homebound”?
To be classified as “homebound,” your ability to leave your home must be extremely limited due to a medical condition. Essentially, it means that you cannot leave your home without assistance or significant effort due to illness, injury, or disability. A doctor will need to evaluate and confirm that you are homebound, and this evaluation is required for Medicare to approve your coverage for home healthcare.
Additionally, you must need intermittent or part-time care, such as daily visits for nursing services or physical therapy. These services will be provided under Medicare’s home healthcare benefits if they are necessary for treating your condition.
For more about qualifying for homebound care under Medicare, check this Medicare eligibility page.
What Home Healthcare Services Are Covered?
Medicare Part A and Part B provide coverage for home healthcare services. These include:
- Skilled Nursing Care: For medical needs that require professional nursing, such as wound care and administering medications.
- Physical, Occupational, and Speech Therapy: These services are provided to help restore function or teach new ways to manage daily activities.
- Home Health Aide Services: These may be covered when part of the care plan involves personal care assistance.
Medicare home healthcare can cover up to 8 hours per day, generally up to 28 hours per week. In certain cases, it may extend to 35 hours per week if your condition requires extra care.
If you need more details about these services, visit Medicare’s home health services page.
Non-Covered Services
However, it’s important to note that certain non-medical home care services are not covered under Medicare. These services include:
- Meal Deliveries: Medicare does not pay for meal services.
- Round-the-Clock Care: 24/7 home care is not covered unless part of a broader care plan.
- Housekeeping and Homemaker Services: Activities like cleaning, laundry, and shopping are not covered unless they directly contribute to your care plan.
- Custodial Care: This includes assistance with activities like dressing and bathing, which are not covered unless there’s a medical need for these services.
Steps to Receive Home Healthcare
Step 1: Enrollment in Medicare
To qualify for home healthcare under Medicare, you first need to be enrolled in Medicare. Typically, individuals are eligible for Medicare when they turn 65 or if they are under 65 and have certain disabilities. If you qualify based on age, you must enroll manually during your designated enrollment period. However, if you qualify due to a disability, you will be automatically enrolled.
Step 2: Visit with a Medicare-Approved Doctor
Once you are enrolled in Medicare, the next step is a visit to a Medicare-approved doctor or healthcare professional. The doctor will evaluate your condition, and if they agree that home healthcare is necessary, they will certify this in writing. This step is crucial, as it ensures that you meet the medical criteria for receiving home healthcare services.
For more on Medicare-approved providers, visit Medicare’s provider search tool.
Step 3: Medicare Coverage for In-Home Healthcare
Once you are approved, Medicare will arrange payment to the healthcare agency for the care you receive over a 30-day period. If you need multiple 30-day periods of care, they will be covered separately. This means that if your condition requires extended care, Medicare will continue covering those costs within its coverage parameters.
Medicare typically covers services provided by certified home health agencies. These agencies must meet certain standards, and if they are Medicare-certified, their services are covered. If you need medical equipment like wheelchairs or oxygen therapy, Medicare Part B will cover 80% of the cost once the annual deductible is met.
How Much Does Medicare Pay for Home Healthcare?
The amount Medicare pays depends on the type of care and the extent of your medical needs. If you are receiving services through a Medicare-certified home health agency, you generally won’t have any out-of-pocket costs. However, if you need additional medical services or equipment, those might be covered under your regular Medicare benefits.
Additionally, Medicare Part B may cover medical equipment like wheelchairs or oxygen, but you will typically pay 20% of the cost after meeting your deductible. For 2025, the deductible is set at $257. You’ll also need to pay your monthly premium, which starts at $185, depending on your income.
If you are enrolled in a Medicare Advantage (Part C) plan, the coverage should be comparable, but your premiums and deductibles will vary depending on your plan.
Key Takeaways
To qualify for Medicare home healthcare, you must be considered homebound and have a doctor certify your need for care. This care is typically covered up to 28 hours per week, with exceptions that may allow for additional hours. Services can include physical therapy, skilled nursing, and home health aide services, but non-medical services like meal delivery or homemaker tasks are not covered.