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Taking the guesswork out of your plan!

Medicare Home Health Care Benefits

If a Medicare beneficiary qualifies for Medicare’s home health benefit, Medicare covers the following types of care:

 Skilled nursing services and home health services provided up to seven days a week for no

more than eight hours per day and 28 hours per week (Medicare can cover up to 35 hours in

unusual cases). Medicare pays all costs for skilled nursing care, which includes services and care that can only be performed safely and effectively by a licensed nurse. Medicare pays all costs for a home health aide if they require skilled services. A home health aide provides personal care services including help with bathing, using the toilet, and dressing. If a person ONLY requires personal care, they do NOT qualify for the Medicare home care benefit.

 Skilled therapy services. Physical, speech and occupational therapy services that can only be

performed safely by or under the supervision of a licensed therapist, and that are reasonable and necessary for treating their illness or injury

 Medical social services. Medicare pays all costs for services ordered by their doctor to help them with social and emotional concerns they have related to their illness. This might include counseling or help finding resources in their community.

 Medical supplies. Medicare pays all costs for certain medical supplies provided by the Medicare-certified home health agency, such as wound dressings and catheters needed for their care.

 Durable medical equipment. Medicare pays 80% of its approved amount for certain pieces of medical equipment, such as a wheelchair or walker. They pay a 20% coinsurance. If they only need occupational therapy, they will not qualify for the Medicare home health benefit. However, if they qualify for Medicare coverage for home health care on another basis, they can also get occupational therapy.

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