If you or your loved ones are on Medicare, you may wonder if Medicare Part A pays for home health care. If so, what services are covered? If not, will a Blue Cross Medicare plan help with out-of-pocket home care expenses?
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Does Medicare cover home health care?
Medicare Part A covers unlimited home health care visits, as long as the services are ordered by a doctor and delivered by a Medicare-certified agency. To be eligible, the person receiving services must be homebound and require periodic or part-time skilled nursing care. This is defined as fewer than seven days a week or less than eight hours a day over a 21-day period.
What home health care services does Medicare cover?
- Skilled nursing services must be delivered at home by a registered nurse (RN) or by a licensed practical nurse (LPN) supervised by an RN. Examples of skilled nursing care include giving IV drugs or shots, changing dressings or managing prescriptions.
- In-home physical therapy, occupation therapy and speech/language pathology are covered if the treatment is required and delivered by qualified therapists.
- Medical services for social and emotional concerns are covered when under the direction of a doctor.
- Medical supplies are covered if ordered by a doctor. Durable medical equipment is partially covered if ordered by a doctor (note: this is paid by Medicare Part B – not Part A).
Regardless of the services, the home health care agency must perform an initial comprehensive assessment of the patient's needs, communicate those needs to the doctor and periodically reassess needs to ensure Medicare coverage.
What home health care services are not covered by Medicare?
Services that could be delivered by a non-medical person (or by yourself) without supervision of a nurse are NOT covered. This includes meals, homemaker services and other personal care services delivered by home health aides.
What if more skilled or special care is needed?
Medicare Part A covers care in a skilled nursing facility in full for 20 days (after a hospitalization of at least three days). After that, you pay a portion of daily costs up to 100 days, as well as any expenses not covered by Medicare. If hospice care is needed, Medicare Part A provides coverage for drugs to control symptoms and minimize pain, as well as home health care.
Do Blue Cross Medicare plans cover home health care?
Blue Cross Medicare plans can help fill gaps in eligible expenses that Medicare Parts A and B don’t cover. However, services that are ineligible under Medicare Parts A and B are not covered by Blue Cross plans. You will need to get prior authorization from your provider for certain services. A prior authorization, or pre-approval for a medical service, helps ensure you are getting proper care. Learn more about prior authorizations and when they're needed.
How do I find home health care resources in my community?
Check with your doctor or hospital social worker, or search online. Just be sure to go with a Medicare-certified home health care agency.
More about Medicare plans
What does Medicare cover?
Choosing a Medicare supplemental plan
How to enroll in Medicare
Learn about Blue Cross Medicare networks