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Does Medicare Provide Coverage to Home Health Aides? Here’s All You Need to Know

Does Medicare Provide Coverage to Home Health Aides

There are times when people need help with their everyday home tasks due to health issues. The home health aides include helping to get ready, assisting in cooking, and taking a bath. Furthermore, it has medically centered tasks such as changing dressings of a wound, checking vitals such as temperature, or taking care of medications. Home health aides are different from personal care aides. Health home care workers are independent, but health professionals in their services supervise them. The education requirement for a health care worker is lenient, but this job requires more focus on the training.

How Medicare Covers Home Health Aides?

The hospital insurance (Part A) and medical insurance (Part B) of Medicare provide coverage to the home health care if your physician finds it medically necessary and prescribed it for you. However, Medicare doesn’t offer coverage to the extended, full-time home health care. The aide must be part-time as well as for a short period, not permanent. 

What Home Health Aides Does Medicare Cover?

Medicare provides the following types of home health services:

  • Half-day or sporadic home health aide
  • Providing robust medical equipment and gadgets in some instances
  • Physiotherapy or occupational therapy
  • Part-time expert nursing care
  • language therapist services
  • Medical skilled social services/workers

Who Are Eligible for Medicare Home Health Aides?

Medicare provides specific rules for the eligibility criteria of home health aide services. According to the requirements, one must have a care plan that is reviewed under your physician’s care regularly. Your doctor must provide a certificate for you to being housebound. Medicare defines “housebound” as people whose health doesn’t allow them to leave their house as well as people that cannot leave the house on their own. Medicare also considers people as housebound if they visit religious services, adult daycare, or doctor’s checkup. 

Furthermore, your doctor must certify one of these services is essential for you:

  • Expert nursing care
  • Physiotherapy
  • Speech therapy
  • Occupational therapy assistants (OTA) 

The Medicare advantage plan covers specific insurance therapies, covering different types and percentages of the cost of treatments but with explicit conditions. 

What Medicare Does Not Cover Home Health Aides?

If a person only requires “custodial” services, Medicare doesn’t cover any home health aide services. It is because custodial care doesn’t need medical expertise. Custodial care includes providing assistance in dressing, eating, bathing, or using the bathroom. These are typical custodial care works; there can be other examples that don’t require medical skills. Furthermore, keep in mind that:

  • Firstly, Medicare also doesn’t cover housekeeper services, such as laundry or cleaning
  • Secondly, Medicare is not responsible for your meals. 
  • Thirdly, Medicare also doesn’t cover caretaker services for round-the-clock at your home.

What Is the Cost of Home Health Services?

If a person meets Medicare coverage eligibility criteria, they don’t have to pay for the home health aides. Although your home health care needs equipment or gadgets, you have to pay the approved Medicare amount, which is only 20% of the equipment cost. 

It is crucial to know what home health care services you require because your physician might recommend more services than your Medicare Insurance cover. Your doctor should advise on what home health services you need or contact Medicare for the details of home health care services. 

Home Health Services in Different Cities

One can apply for a demonstration program of Medicare. You can also request a review of your claim given in the program. The review might help you to decide whether Medicare is your home health aide or not. If your doctor recommends home health and you live in one of the states mentioned above in the U.S, you should immediately request the pre-claim review to know if you have to pay for the services.