Medicare and Home Health Care - Covered Services
Medicare Home Care Information and Statistics
Medicare may pay for you to get health care services in your home. You must meet certain eligibility criteria. And the services need to be considered reasonable and necessary for the treatment of your illness or injury.
In 2020, about 3.1 million Medicare fee-for-service beneficiaries received care, and the program spent $17.1 billion on home health care (HHC) services. Spending declined by 4.7 percent compared to 2019.
For 2023 the Medicare Payment Advisory Commission recommends reducing the 2022 home health PPS base payment rate by 5 percent.
What Is Not covered by Medicare?
Many home assistance needs are NOT covered by Medicare. That’s a reason to look into insurance that pays for care in your own home. More details are provided below.
The following is directly from the Medicare.gov website. “Medicare doesn’t pay for:
- 24-hour-a-day care at your home
- Meals delivered to your home
- Homemaker services (like shopping, cleaning, and laundry) that aren’t related to your care plan
- Custodial or personal care that helps you with daily living activities (like bathing, dressing, or using the bathroom), when this is the only care you need”
Who is eligible for Medicare’s Home Health benefits/coverage?
- You are covered by Medicare and under the care of a doctor.
- Services provided under a plan of care established and reviewed regularly by a doctor.
- A doctor certifies that you need, one or more of these:
- Intermittent skilled nursing care (other than drawing blood)
- Physical therapy
- Speech-languagepathologyservices
- Continued occupational therapy
- The home health agency is approved (certified) by Medicare.
- A doctor certifies that you’re homebound.
Home Care Benefits Paid By Medicare (2020)
Some 3.1 million Medicare FFS (fee for service) beneficiaries received services categorized as home care.
The Medicare program spent $17.1 billion on HHC services. Total spending for HHC declined by 4.7 percent compared to the prior year.
The following is from the Report to Congress (March 15, 2022) by the Medicare Payment Advisory Commission.
Over 11,456 Home Health Agencies (HHA) participated in Medicare (2020). Over 99 percent of beneficiaries lived in a county served by at least one HHA.
In January 2020, CMS implemented major changes to the payment system for home health care services. A key change included shortening the unit of payment from 60 days to 30 days.
Insurance To Cover What Medicare Doesn’t
While 17.1 Billion sounds like a lot, it really isn’t. Most people who need some form of assistance in their own home are NOT covered by Medicare.
That’s a reason to consider either a home care only policy or a long-term care insurance policy. These can provide benefits for the many situations where Medicare doesn’t pay.
You can learn more about these by visiting the website of our sister organization, the American Association for Long-Term Care Insurance.
Learn more about home care insurance (also called short-term). Click the link.
Request a free long-term care insurance cost quote for coverage that pays 100% of the policy benefits for care in your own home.
Valuable Resources for More Information
Click to see latest Medicare insurance statistics and data.
Learn more about Medicare Long-Term Care coverage for skilled care needs.