First things first: you must be enrolled in Medicare. Specifically, you must have Original Medicare (which consists of Parts A and B) or Medicare Advantage (Part C). Part A covers inpatient hospitalizations, care in a skilled nursing facility, palliative care, and some home health care services. Part B covers medically necessary services, such as doctor visits, outpatient care, and some home health care services.
With the many threats currently facing the Medicare program, now is the time to come together as partners and explore ways to advocate for comprehensive Medicare coverage, health equity and quality health care. No, Medicare usually covers 100% of all approved home health care costs, but you may have to pay 20% of the amount approved by Medicare for any durable medical equipment. The agency must also let you know (both verbally and in writing) if Medicare won't pay for the items or services it provides and how much you'll have to pay for them. To qualify, your loved one must first meet the eligibility criteria for home health care covered by Medicare.
If you're thinking about getting home health care and are wondering if Medicare will cover it, you're in the right place. Even with all of this information, differentiating between home care and home health care can be confusing. Medicare can extend that limit if your doctor can predict when your daily need for skilled nursing care will end. Home health agencies must provide advance notice of lack of coverage (ABN) to the beneficiary before providing services or supplies that Medicare is unlikely to cover.
While it's increasingly difficult to get home health aides covered by Medicare, this care is an integral part of the Medicare home health care benefit. Home health care services are designed to be of short duration to help a person recover or maintain their health. The Medicare home health care benefit is not a long-term service and support program, and it doesn't provide unlimited coverage. However, Medicare may temporarily cover custody care if it's part of a general care plan that includes specialized home health care.
Medicare pays for home health care for eligible older people who are homebound and who require essential medical services for the treatment of an illness or injury. Then, non-medical home care services, such as help with ADLs, may be covered as part of the general care plan. Medicare home health care is designed to provide specialized care, meaning that the services you need can only be provided by a licensed health professional.
