Home health care offers a range of medical services delivered right in your home, providing a convenient and often more affordable alternative to hospitals or skilled nursing facilities (SNFs) for those recovering from illness or injury. If you’re considering this option, especially for yourself or a loved one on Medicare, a key question arises: How Long Does Medicare Pay For Home Health Care?
Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) can cover home health services if you meet specific criteria. The coverage isn’t based on a fixed time limit but rather on your medical needs and whether you meet certain “homebound” and skilled service requirements.
To be eligible for Medicare’s home health benefit, you must be considered “homebound.” This doesn’t mean you can never leave your house, but it does imply significant difficulty. You’re typically considered homebound if:
- Leaving home is challenging without assistance, such as needing a cane, wheelchair, walker, crutches, special transportation, or help from another person due to an illness or injury.
- Your doctor advises against leaving home because of your health condition.
- Leaving home is a major effort for you.
Alt text: Home health care professional assisting senior woman with walker at home, representing Medicare covered services.
Beyond the homebound requirement, Medicare also mandates that you need part-time or intermittent skilled services. These services must be medically necessary and ordered by a doctor or a certified health care provider like a nurse practitioner. A Medicare-certified home health agency must provide the care. Before services begin, you’ll also need a face-to-face assessment with a doctor or provider to certify your need for home health care.
So, what kind of services are covered under Medicare’s home health benefit? Covered services include:
- Skilled Nursing Care: This can include part-time or intermittent care for needs like wound care (including pressure sores or surgical wounds), patient and caregiver education, intravenous or nutrition therapy, injections, and monitoring serious illnesses or unstable health conditions.
- Physical Therapy: To help regain mobility and manage pain.
- Occupational Therapy: To assist with daily living activities and improve functional abilities.
- Speech-Language Pathology Services: To address communication or swallowing difficulties.
- Medical Social Services: To provide counseling and support related to your medical condition.
- Home Health Aide Care: This includes part-time or intermittent assistance with personal care tasks like walking, bathing, grooming, changing bed linens, and feeding. Crucially, home health aide services are only covered if you are also receiving skilled nursing care, physical therapy, speech-language pathology services, or occupational therapy at the same time.
- Injectable Osteoporosis Drugs for Women: To treat osteoporosis.
- Durable Medical Equipment (DME): Such as wheelchairs, walkers, or hospital beds, for use at home.
- Medical Supplies: For use at home, as needed for your care.
- Disposable Negative Pressure Wound Therapy Devices: For wound treatment.
Alt text: Nurse taking blood pressure of elderly patient in her living room, illustrating skilled nursing care covered by Medicare home health benefits.
Regarding the duration of care, Medicare’s definition of “part-time or intermittent” typically allows for skilled nursing care and home health aide services for up to 8 hours per day combined, with a maximum of 28 hours per week. In certain situations, if your provider deems it medically necessary, you might receive more frequent care for a short period, up to 35 hours per week, but still less than 8 hours each day.
It’s important to understand what Medicare does not cover under the home health benefit. Medicare does not pay for:
- 24-hour-a-day care at home.
- Home meal delivery services.
- Homemaker services like shopping or cleaning that are not directly related to your care plan.
- Custodial or personal care when it’s the only care you need. This includes assistance with daily living activities such as bathing, dressing, or using the bathroom, if you don’t also require skilled care.
You won’t continue to qualify for home health benefits if your need shifts to more than part-time or “intermittent” skilled care. While you can leave home for medical appointments or short, infrequent outings for non-medical reasons like religious services, you can still receive home health care if you attend adult day care programs.
In conclusion, Medicare pays for home health care as long as you continue to meet the eligibility requirements, including being homebound and needing intermittent skilled care. There isn’t a set time limit, but the care is designed to be part-time and focused on skilled medical needs rather than long-term personal or custodial care. If you believe you or someone you know might benefit from home health care, discussing your needs with a doctor is the first step to determine eligibility and explore available Medicare-certified home health agencies in your area.
