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How Medicare Can Help

Will Medicare pay for home health care?

Medicare covers home health care that is temporary and part-time, but only if you meet these requirements:

  • Your doctor must say that you need the care. Your doctor must document that you need care at home and make a plan for that care.
  • You must need skilled care or therapy (physical, speech or occupational).
  • You must be homebound. Homebound means that leaving home is a major effort and you cannot do it without help. When you do leave home, it must be to get medical care, or in short, infrequent non-medical reasons such as a trip to get a haircut or to attend religious services or adult day care.
  • The home health agency must be Medicare-approved. For a list of approved agencies, visit www.medicare.gov or call 1-800-MEDICARE.

What kinds of home health care will Medicare pay for?

If you meet all the requirements for home health care (See Question #1), Medicare will pay for:

  • Occasional skilled nursing care: This is care that can only be done safely and correctly by a licensed nurse (either a registered nurse or a licensed practical nurse).
  • Physical therapy: Physical therapy includes exercise to regain movement and strength to part of your body and training on how to use special equipment to take care of yourself.
  • Speech-language therapy: Speech-language therapy is exercise to help you speak more easily and clearly.
  • Occupational therapy: Occupational therapy helps you do the daily activities by yourself, such as eating, putting on your clothes or combing your hair.
  • Medical social services: These services can help you with social and emotional concerns related to your illness. For example, you might need counseling or help finding resources in your community.
  • Some medical supplies such as wound dressings, but not prescription drugs.
  • Some medical equipment such as a wheelchair or walker.

Does Medicare pay for personal care like bathing, help using the toilet or help with dressing?

Medicare might pay for these services, if you are also receiving skilled care such as nursing care or other therapy. Also, care is only covered by Medicare if the patient is confined at home while recovering from a specific illness, injury or acute condition. Once the patient is no longer actively “recovering,” or if the patient needs care because of a long-term condition (like dementia) or general frailty, Medicare will not cover it. Medicare does not pay for 24-hour-a-day home care, prescription drugs, meals delivered to your home or homemaker services such as cleaning, laundry and shopping.

I have a relative who is a registered nurse. If she provides home health care for me, will Medicare pay for it?

Not unless she is employed by a home health agency approved by Medicare.

Do I have to pay any deductibles or co-payments for home health care?

No. You do not have to pay for anything except 20 percent on certain kinds of durable medical equipment. There is no time limit on home health care as long as you continue to meet the requirements.

I live alone and can’t care for myself. Will Medicare pay for 24-hour-a-day home health care?

No. Medicare pays for occasional or part-time home health care, but not for around-the-clock home health care.

Better Living Senior Assistance Services Contact Information

Please contact us with your questions and concerns. We will also appreciate suggestions from you.