Medicare pays your home health agency one payment for covered services for each 30-day period of care. Those services can include part-time skilled nursing care, physical therapy, occupational therapy, speech-language pathology services, and more. If you are unsure whether Medicare will pay for a specific service, have your agency submit the claim to Medicare for an official payment decision.
Pay for Medicare-Certified Home Health Agencies
When you receive care from a Medicare-certified home health agency, you simplify the costs and help to lessen your out-of-pocket spending. If your home health agency is Medicare-certified, that means it will be paid by Medicare and will accept only the Medicare-approved amount for covered services. You won’t have to worry about excess charges.
Medicare pays your home health agency with one payment for 30 days of covered services.
Home Health Care Medicare Coverage
To qualify for home health services, your doctor will need to certify that you are homebound, and will develop and review a plan of care requiring intermittent skilled nursing care, physical therapy, speech-language pathology services, or occupational therapy from a Medicare-certified home health agency. Medicare will also cover home health aide services, medical social services or medical supplies if you are also receiving other skilled care. In general, these services must be deemed reasonable and necessary.
Part-time skilled nursing services must last for fewer than eight hours each day and 28 or fewer hours per week and be provided by a registered nurse (RN) or a licensed practical nurse (LPN) whose care is supervised by an RN.
Medicare does not cover 24-hour care, delivered meals or services outside of skilled medical care. This coverage also does not include personal care services if those activities of daily living are the only services you need.
Your Costs for Home Health Care
Any durable medical equipment you receive as part of your care will be covered under Medicare Part B, instead of the home health benefit. You would be responsible for 20% of the cost for this type of equipment, and your home health agency may be able to help deliver these items to your home.
For care that won’t be covered by Medicare, you will pay the full cost. If you will need to pay for services, your home health agency will provide a written notice called the Advance Beneficiary Notice of Noncoverage (ABN). Your home health agency will give you notice if they expect that Medicare will not pay for a service, but you can ask the agency to send the claim to Medicare for a payment decision. You will be refunded the money you paid for these services, except for coinsurance and deductibles.