Does Medicare Cover Home Health Care?

Over 62 million Americans rely on Medicare for their healthcare coverage, and the number of people covered by this program is expected to reach 100 million by 2075. However, Medicare rules are complicated, and many people are confused about their coverage. In this comprehensive article, Nurse Next Door McLean helps you understand what Medicare covers. You will find answers to questions like: Does Medicare cover cataract surgery? And does Medicare cover chiropractic care? We’ll help you make an informed decision for you and your family.

Understanding How Medicare Coverage Works

Medicare has multiple parts, each with its own specific coverage.

• Part A – Hospital visits and stays, skilled nursing care, some home health services, and hospice care
• Part B – Outpatient care, some prescriptions, oxygen, Durable Medical Equipment such as mobility aids, hospital beds, and diabetes supplies (if it has been ordered by your primary doctor/physician who is enrolled in Medicare)
• Part C – Private Medicare Advantage insurance plans combine Parts A and B, with some added benefits, such as vision, dental, or hearing. Those with a Medicare Advantage Plan have to abide by the rules of the plan, including using their hospitals and doctors. Besides this, instead of paying the 20% coinsurance, you have to pay copays. Referrals may be required. While certain plans extend to additional things like dental, the rules to get home health and other services might be different.
• Part D – Private prescription insurance
• Private supplemental insurance fills in any gaps in Medicare coverage.

You don’t need to pay anything for the nurse or therapist with regard to home health. However, if you need medical equipment, such as a wheelchair, you will pay 20% of the cost.

In case of cataract surgery, you’ll have to pay 20%. Your Medigap plan or Medicaid may help you pay for it.

Those who opt for hospice care pay small copays for the drugs as well as respite care.

Does Medicare Cover Home Health Care?

Medicare defines “home health care” as skilled, medically-necessary services delivered in your home by a certified home health agency. The services are ordered by your doctor and provided by skilled medical professionals such as nurses or therapists.

To qualify, you must be homebound, meaning you have difficulty leaving your home without assistance.

Medicare DOES NOT COVER “unskilled” non-medical at-home care, such as companionship, personal care (bathing, grooming, and dressing), meal planning and preparation, light housekeeping, transportation, or errands – unless it is also provided in conjunction with skilled nursing or therapy services.

Medicare DOES NOT COVER around-the-clock custodial care. Covered home health care must be intermittent, medically necessary, and provided under a doctor’s direction. Long-term custodial care is typically covered by private insurance or paid for out-of-pocket by patients or their families.

With intermittent or part-time home health services, a client can receive services from a skilled nurse and home health aide as per the needs determined by the doctor.

Keep in Mind: Medicare isn’t a long-term care insurance and will pay for the treatments if your doctor determines that they’re medically necessary.

Now let’s look at some specific conditions:

Does Medicare Cover Cataract Surgery?

Medicare covers lens replacement surgery, anesthesia, follow-up exams, facility fees, and one pair of glasses after the surgery.

NOT Covered: Upgraded lenses or cosmetic add-ons.

After you meet your Part B deductible, you pay 20% of the Medicare-approved amount of the procedure.

Does Medicare Cover Chiropractic Care?

We’ve already answered the broader question: Does Medicare cover home health care? Now, let’s explore a specific service. Around 11% of American adults visit chiropractors, typically to deal with pain. Chiropractic is a popular alternative to dangerous and addictive opioid medications.

What Does it Cover? Spinal manipulation for subluxation – i.e., when the spinal joints still make contact but fail to move properly.

NOT Covered – Maintenance adjustments, massage therapy, acupuncture, X-rays, or other tests ordered by the chiropractors.

Does Medicare Cover Hospice Care?

In 2024, 1.8 million Medicare beneficiaries received hospice services – palliative care for a terminal illness.

What It Covers – Hospice patients may qualify for any or all of the following:

• Palliative and supportive services by doctors, nurses, physical/occupational therapists, and home health aides
• Medications and short-term inpatient care for the management of pain and symptoms
• Medical supplies
• Durable medical equipment for pain relief and symptom management
• Homemaker services
• Dietary counseling
• Respite care, up to 5 days
• Social services – spiritual and grief counseling for the patient and family

NOT Covered –  Patients entering hospice care receive comfort care and support only, meaning they no longer receive treatment or medications intended to cure their condition.

Services that are not covered by Medicare include any inpatient, outpatient, or emergency care, unless it is unrelated to the terminal illness.

Medicare does not cover room and board for hospice patients or their families.

Once hospice care is chosen, Medicare benefits should cover everything needed, but you might face a small copay for a few medicines, amounting to approximately $5, or around 5% in case you opt for respite care.

How Nurse Next Door McLean Helps Seniors Navigate Medicare Coverage

As your most trusted home health care provider in Virginia, Nurse Next Door McLean understands the challenges you may face while navigating Medicare coverage.

We are here to help and provide detailed answers to questions such as: Does Medicare Cover Hospice Care?

Nurse Next Door McLean can guide you on the process to qualify for home health care under Medicare and help you understand your coverage.

If you need home healthcare services but are unsure about your Medicare coverage, call Nurse Next Door McLean at (703) 774-9421, and we will guide you.

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FAQs

Does Medicare Pay for Health?

Mostly. While Medicare does not cover 100% of all possible medical expenses, it does cover a significant portion of most medically necessary services for eligible people.

What Conditions Does Medicare NOT Cover?

Medicare does not cover most dental, vision, or hearing care, cosmetic surgery, weight-loss medications, long-term personal care, or routine foot care.

What Diseases are Covered by Medicare?

Medicare covers a wide range of treatments and services for illnesses, including chronic diseases (diabetes, Alzheimer’s, COPD, etc.), neurological diseases (epilepsy, Lou Gehrig’s, etc.), cancer, and mental health disorders. However, your doctor needs to determine that it’s a medical necessity.

What are Some Things That are Covered under Medicare?

For properly-enrolled beneficiaries, Medicare Parts A-D cover most medically-necessary services, supplies, equipment, and medications. Here is a complete alphabetical list.

Do You Need More Information or Guidance?

Consider official channels like:

• State Health Insurance Assistance Program (SHIP): It’s a free service provided by the government. Search for your local SHIP online and let counselors guide you about Medicare.
• Medicare.gov assists you with plan finder tools.
• Or get help from the official government website at 1-800-MEDICARE.

Next Steps: 

• Explore the handbook: Medicare & You.
• Those with Original Medicare should visit Medicare.gov.
• For the Medicare Advantage Plan, either call the plan or read the booklet: Evidence of Coverage.
• Get in touch with your SHIP counselor for free and local guidance.
• If you need a service, ask your doctor if it will be covered by Medicare.

NOTE: This article provides general information. Call 1-800-MEDICARE or the Medicare Advantage Plan to get exact information about your coverage.