Q & A - what home health care benefits Medicare covers

Q & A – what home health care benefits Medicare covers

Q:  My 89-year-old mother was recently hospitalized and held for observation due to suspicious chest pain.  She has been released, but my husband and I are considering moving her in with us.  We are wondering what home health care benefits Medicare covers.

A:  A lot depends on how functional your mother is.  Home health care commonly refers to a wide variety of health and other services that are provided at home to recovering, chronically - or terminally - ill people.  Medicare should help pay, but ONLY if your mother meets all four of the following qualifications:

  1. She meets the legal definition of homebound.  Medicare defines homebound as needing the help of another person or special equipment like a wheelchair, walker or crutches to leave your home, or the doctor believes leaving home would be harmful to her health.  In addition, it has to be difficult for your mother to independently leave your home and she could not do so without assistance.
  2. She needs skilled care.  Skilled care includes nursing care on an intermittent basis, which can be as much as once a day for three weeks (or longer if she has a need and continues to qualify for more care.)  Skilled care can include physical, occupational or speech therapy.
  3. Her doctor signs a home health certification with a plan of care.  From the start of care, or shortly thereafter, the doctor must confirm that he/she or certain other health care providers have had a face-to-face meeting with the patient, that your mom qualifies for Medicare home care because she is homebound, and that she needs intermittent skilled care.  The certification usually includes the plan of care on one form, which is then submitted to Medicare.
  4. Your mom receives care from a Medicare certified home health agency.


Unfortunately, Medicare’s coverage of the home health benefit is limited.  Here’s what’s NOT covered:

  • Prescription drugs.  Your mom will continue to need her Part D coverage or to be enrolled in a Medicare Advantage Plan with Part D coverage.
  • Meals delivered to your home.  If you can’t provide most or all the meals or even if you just need a brief break from caregiving, you may want to look into your local Meals on Wheels or senior meals program.
  • Day care at home.  If you bring your Mom home, you will need to plan to provide most of the daily care yourself or be prepared to hire aides at additional cost to provide help.  If your mom’s income is low, you might want to look into Medicaid programs that can assist with home or adult day care.
  • Custodial care, or getting your mom to doctors’ appointments:  Be prepared to pay out of pocket if you and your mom need help with cooking, laundry, shopping or managing and providing transportation to doctor’s appointments.

Before making any final decisions to move your mom in with you, we highly recommend that you assess your local resources.  Check your local senior centers, Area Agency on Aging, or call the Eldercare Locator 1-800-677-1116.  You can call 1-800-MEDICARE for a list of home health agencies in your area.  If your mom gets her coverage through a Medicare Advantage plan, you will need to call the plan to find out which agencies are in the plan’s network.