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Will Medicare pay for home care services?

Status: Open    Mar 08, 2015 - 01:23 AM

Medicare/Medicaid

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Expert Answers

Mar 26, 2015 - 01:03 PM

Medicare has specific rules for providing home care services, called Conditions of Participation.

Two of these conditions are that the care is provided under a physician’s signed orders and the plan of care includes skilled services. Skilled services are those provided by licensed nurses and/or therapists. All home health services are expected to be part time or intermittent, including aide services.

If the needed services are for assistance with activities if daily living, such as bathing, eating or walking, but no skilled services, such as wound care or physical therapy, Medicare will not cover the services. However, if the individual is eligible for Medicaid, these services might be covered. Many long term care insurances will also cover these services.

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Aug 24, 2016 - 09:17 AM

Medicare does not pay for home care services unless the patient has had a three night hospital stay which triggers the covered person's skilled nursing benefit. Medicare sometimes allows those benefits to be administered at home instead of at a skilled nursing facility.

Aug 25, 2016 - 03:24 PM

Check with a hospice provider also. Patients can go on and off of hospice, depending on condition, and Medicare does cover it with the right circumstances and diagnosis.

APFM Staff Answers

Aug 25, 2016 - 03:22 PM

Rules & conditions about covered home health care can be found on the Medicare.gov website - this site will always have the most up to date information.

Source: www.medicare.gov

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