Medicare may cover certain home health care services if you’re eligible and your care is medically necessary. Home health care can be a great option if you have difficulty traveling. This type of care may include a variety of skilled medical services offered to you in your own home. It’s often less expensive than a skilled nursing facility stay because you don’t pay costs like room and board. And if you have Medicare, home health care may cost even less.
What is home health care?
Home health care is a range of medical services you can get in your home. You might get it to help recover from an illness or injury, or to monitor unstable health status. For example, you might get part-time skilled nursing care at home if you need physical therapy after surgery. Home health care may be a safer option than care in a facility. It also offers more independence. But Medicare will only cover this care in short-term situations.
What home health care services are covered by Medicare?
Medicare Parts A and B usually provide Medicare home care coverage if you qualify. Here are some home care services covered by Medicare:
- Part-time skilled nursing care (must be medically necessary)
- Physical therapy, occupational therapy and speech-language pathology services
- Medical social services
- Durable medical equipment
- Non-medical support like bathing and feeding (only if you’re also getting skilled nursing care or a therapy service)
- Home health aides
- Virtual care
For Medicare to cover them, all caregiving services must be from licensed providers. This coverage is also only for intermittent care. That means short-term, noncontinuous care. Constant, long-term care is not covered by Medicare Parts A and B. Here are some other examples of care that is not covered:
- 24-hour care
- Home meal delivery
- Homemaker services (like shopping or cleaning)
- Custodial care (if this is the only care you need)
Home health benefits with Aetna® Medicare Advantage plans
Aetna Medicare Advantage plans cover many licensed caregiving services. They may include skilled nursing care, physical and speech therapy, and durable medical equipment. Some Aetna Medicare plans may also offer coordinated care and added support for recovery at home. Coordinated care can reduce hospital readmissions and lead to better long-term health results.
Find the right Aetna Medicare Advantage plan for you
Who qualifies for home health care services?
So, who is eligible for home health care? You have to meet certain requirements to get coverage.
To qualify for home health care with Medicare:
- You must have difficulty leaving your home because of illness or injury.
- A health care provider must recommend that you do not leave home because of your condition.
- A health care provider must order skilled medical care for you from a Medicare-certified home care agency.
- You must get a document explaining the home health care you will receive from this home care agency. It should include things like the care you need, what health care professionals will provide it and how often you will need care.
If you qualify, you can get covered care for up to 28 hours per week. You may be able to get up to 35 hours if necessary (fewer than 8 hours per day).
So, once you know you’re eligible, what’s next? If you’re a member, you can start taking advantage of your Aetna benefits. If you’re not a member, learn more about Aetna Medicare Advantage plans and find the right plan for your home care needs.
What is the difference between personal home care and skilled home health care?
Skilled home care offers health-related services like injections and physical therapy. Skilled nursing care is an example of this. Personal home care offers nonmedical services like bathing and feeding. Medicare Part A and B do not usually cover personal care services unless you’re also getting skilled home care. Some Aetna Medicare Advantage plans may offer added benefits for personal home care.
How much does Medicare pay for home health care?
It’s important that you understand home health care costs before starting to receive care. You will usually pay $0 for all covered home health services. You pay 20% of the Medicare-approved amount for durable medical equipment after you’ve paid your Part B deductible. Your home care provider should explain all these costs to you before beginning your care. They should also explain if any part of your care will not be covered.
