Does Medicare Cover Home Health Aides? 

Staying healthy at home is important for everyone, but for seniors, this can sometimes be difficult. Some seniors with mobility challenges find it hard to get to a doctor’s offices. If you live alone, you could be at an even greater risk if your health declines due to illness or injury. These factors can lead to fewer visits to doctors and a need for home health care.

Options in home health care 

The good news is that solutions are available to overcome health challenges in your home. Telehealth services, for instance, allow seniors who are homebound or who experience mobility concerns to seek treatment over the phone or through video conferencing. These tools provide a virtual person-to-person experience with a medical professional and can be efficient alternatives to in-office visits.  If you’re unable to easily leave your home, video doctor appointments can get you the care you need in a timely manner. 

If you are facing a chronic condition or need more help than you can get from family or friends. Home health aides can be a great resource for seniors who need in-home care on a temporary or intermittent basis. The cost of having a home health care aide may be concerning, especially if you’re on a fixed income. Medicare may be able to help cover the cost of home health services, but it may depend on your specific needs. 

What is a home health aide?

A home health aide is a medical professional who assists people with basic healthcare needs in the home. It’s important to draw a distinction between a home health aide and a caregiver. A caregiver service may send a worker to your home in much the same way as a home health aide, but a home health aide is a healthcare professional who is licensed to provide medical care.

A caregiver may help with some of the same things as a home health aide, but some caregivers may also help with daily activities, such as bathing, eating, and cleaning. Medicare doesn’t help cover the cost of custodial care. The costs of a caregiver who assists with meal preparation, light housework and transportation to things like pharmacies and doctor appointments may come out of your own pocket. 

Does Medicare cover home health aides?

Medicare insurance provides coverage for some home health aide services, but you must be classified as homebound to qualify. The Centers for Medicare & Medicaid Services (CMS), the government agency that oversees Medicare, states that Medicare recipients who cannot leave the house or who have great difficulty leaving the house are considered homebound. Additionally, Medicare recipients who have documented health conditions that would make it dangerous to leave the home may also be classified as homebound.

How Medicare benefits cover home health aides

If you meet Medicare’s qualifications, services provided by a home health aide are covered by Medicare Part A and Medicare Part B. These are the inpatient and outpatient portions of Medicare, respectively.

The reason home health aides are covered by both parts of Medicare comes down to the organization that supplies care. If you have recently been released from a hospital and require at-home care during recovery, a home health aide may be supplied by the hospital to provide medically necessary skilled nursing care. In this case, the in-home care is covered by Medicare Part A.

Medicare Part B may help provide coverage for home health care with durable medical equipment (DME). Medical equipment supplied for home health services requires a coinsurance of 20% after you have met your Part B deductible. You may have to get your equipment from a supplier who accepts assignment. If you’re enrolled in a Medicare Advantage plan, you may have to use a supplier within the plan’s network to have the costs covered.