08/26/2025
✅ What Medicare Covers (Home Health Care)
Medicare Part A and/or Part B covers home health services if the patient:
Is homebound (leaving home requires major effort/assistance)
Needs intermittent skilled nursing care (not full-time daily care)
Needs skilled therapy (PT, OT, ST)
Is under a doctor’s care with a plan of care
Services are provided by a Medicare-certified agency
Covered Services Include:
Skilled Nursing (part-time, not 24/7)
Physical Therapy (PT)
Occupational Therapy (OT)
Speech-Language Pathology (ST)
Medical Social Services
Part-time or intermittent Home Health Aide (only if also receiving skilled care)
Medical supplies for use at home (like wound dressings)
Durable Medical Equipment (DME) (wheelchair, walker, oxygen) at 80% cost (20% paid by patient/secondary insurance)
❌ What Medicare Does NOT Cover
24/7 in-home care (no full-time daily nursing)
Custodial care (help only with ADLs like bathing, dressing, cooking, cleaning, when skilled care isn’t needed)
Meal delivery services
Homemaker services (housekeeping, laundry, shopping)
Personal care assistance (like bathing/toileting) UNLESS you’re also getting skilled nursing or therapy
📌 Key Point: Medicare covers clinical, skilled services — but not long-term custodial or personal care unless tied to a skilled care plan.
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