Kelly Blackwell is a Certified Senior Advisor (CSA)®. She has been a healthcare professional for over 30 years, with experience working as a bedside nurse and as a Clinical Manager. She has a passion for educating, assisting and advising seniors throughout the healthcare process.
Home health aides are specially trained to assist with your care needs in the safety and comfort of your home. Medicare will pay for limited home health aide services if you meet eligibility requirements for home health care and receive your care from a Medicare-certified home health care agency.
Read on to learn about Medicare’s stipulations and benefits for home health care coverage, including home health aide services.
Does Medicare Cover Home Health Aides?
- You also have other skilled services in the home, such as nursing, physical therapy, occupational therapy, or speech-language pathology.
- You are receiving home health services from a Medicare-approved (certified) home health agency that complies with federal and state regulations governing home health aides.
- Home health aides providing services meet all federal and state requirements and are supervised by a skilled professional.
- Home health aide services are part-time or intermittent and match the amount, frequency, and duration established by the physician’s plan of care.
- Home health aide services are reasonable and necessary to the treatment of your illness or injury.
- Home health aides providing services are certified or licensed, in good standing with your state’s regulatory agency, and operate within their scope of practice and level of training and competency.
- Compared to skilled nursing services, home health aide services do not exceed eight hours per day and 35 hours per week.
Who Qualifies for Home Health Services Through Medicare?
You qualify for home health services through Medicare if your medical condition warrants it and you don’t need more than intermittent care. For instance, you may receive home health care after being treated and discharged from the hospital for an illness or injury until you are more self-sufficient.
To be eligible for home health services through Medicare:
- You must have a face-to-face encounter with a doctor or nurse practitioner related to your need for home health care.
- Your physician must certify the services as medically necessary and prescribe a plan of care that details the services you need. Your plan of care must be reviewed and renewed (if appropriate) at least every 60 days.
- You must need intermittent skilled nursing care or therapy services from a physical therapist, occupational therapist, or speech-language pathologist.
- You must be homebound; that is, you can only leave your home with considerable difficulty and require assistance to do so.
- You must receive your home health services from a Medicare-approved home health agency.
What Kinds of Home Health Services Does Medicare Cover?
Home health services are provided in your home versus in a hospital or skilled nursing facility. Home health care is less expensive and more convenient for you because it is provided in the comfort of your home. The goals of home health services are to:
- Help you get better, regain your independence, and help you become as self-sufficient as possible (when you are, you will no longer need or qualify for home health care)
- Maintain your current level of functioning, so your condition doesn’t worsen
- Slow your decline
The kinds of Medicare-covered home health services you may receive include:
- Part-time or intermittent skilled nursing care that can only be provided by a licensed nursing professional and to coordinate your plan of care (less than eight hours per day, no more than 35 hours per week, and typically limited to three weeks)
- Physical therapy to help minimize pain and improve flexibility
- Occupational therapy to help improve your ability to safely function and move around
- Speech-language pathology to help with swallowing or speech
- Medical social services to provide emotional and social support and help you access community resources (you must also have skilled professional services like nursing or therapy)
- Part-time or intermittent home health aide services to provide personal hands-on care (maximum hours are included in the hours allowed for skilled nursing care)
- Injectable osteoporosis drugs for women who have a bone fracture related to postmenopausal osteoporosis and who are unable to self-administer
Here are the kinds of home health aide services you may receive (all must be documented in your individualized plan of care and supervised by a skilled professional):
- Personal care like bathing, grooming, caring for your hair and nails, mouth care, foot care, changing your bed sheets if you are incontinent, feeding, routine catheter care, helping you walk or transfer from the bed to a chair.
- Simple dressing changes
- Help with pre-filling your insulin syringes
- Help with routine maintenance exercises you learned from your physical or occupational therapist
- Help you practice the communication skills you learned from your speech-language pathologist.
- Meal preparation and light housekeeping, only if the home health aide primarily provides personal care.
What Kind of Medicare Coverage is Best if You Need Home Health Aides?
Home health aide services are covered under Medicare Part A, long as you qualify for home health services and require the services of another skilled professional. Your copay for home health aide services provided within the limits set by Medicare is $0. You can receive your services from any Medicare-approved home health agency.
If you have a Medicare Advantage Plan instead of Original Medicare, your requirements and coverage for home health aide services are the same. Home health aide services are a Medicare-covered service under Part A, so Medicare Advantage Plans must offer the same coverage as Original Medicare. Your Medicare Advantage Plan may require you to receive home health care services from an in-network home health agency, and a copay or coinsurance may apply, depending on your plan.
If you receive your Medicare benefits through a Medicare health plan (not Original Medicare), contact your plan to find out how it provides your Medicare-covered home health benefits.
What Home Health Aides Are Not Covered by Medicare?
Home health aides are also called nurse aides or certified nurse aides who have completed federal and state-mandated training and maintain a license or certification through their state. Medicare will cover licensed or certified aides when their services are part of a plan of care provided by a Medicare-approved home health agency.
Medicare will not cover home health aides who do not meet the above requirements or home health aide services that aren’t reasonable and necessary. Nor will Medicare cover home health aide services that exceed the daily or weekly limit outlined on the plan of care.
Sometimes people refer to personal care providers, personal companions, or homemakers as “home health aides.” Even though their services are valuable and necessary for many seniors, Medicare will not pay for them.
Homemaker services like shopping, cleaning, and laundry are not covered, even if the individual providing them is a licensed or certified home health aide. Medicare also won’t cover custodial or personal care like bathing, grooming, and assistance using the bathroom if this is the only care you need.
Learn More From Our Sources
- CMS | Medicare Benefit Policy Manual | Last Accessed September 2021
- CMS | Home Health Aide Qualifications | Last Accessed September 2021
- Medicare | Home Health Service Coverage | Last Accessed September 2021
- Medicare | What is Home Health Care? | Last Accessed September 2021
- Medicare | Medicare and Home Health Care Official Government Booklet | Last Accessed September 2021