Medicare Part A vs Part B: What Covers Home Health Care?
Confused about whether Medicare Part A or Part B covers home health care? You're not alone. This guide clarifies exactly what each part covers and how to maximize your benefits.
Quick Answer:
Medicare Part B (Medical Insurance) is the primary coverage for home health care services. Part A only covers home health if you're also receiving skilled nursing or therapy after a qualifying hospital stay.
Understanding the Basics
Medicare Part A
(Hospital Insurance)
Primarily covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care following a hospital stay.
Medicare Part B
(Medical Insurance)
Covers medically necessary services including doctor visits, outpatient care, preventive services, and most home health care services.
Home Health Care Under Part B
Medicare Part B is your primary coverage for home health services. It covers:
What Part B Covers (100% - No Copay):
- Intermittent Skilled Nursing Care: Part-time or occasional nursing visits
- Physical Therapy: To improve mobility, strength, and function
- Occupational Therapy: To regain daily living skills
- Speech-Language Pathology: For communication or swallowing difficulties
- Medical Social Services: Counseling and assistance with healthcare resources
- Home Health Aide Services: Personal care (bathing, dressing) when receiving skilled care
- Medical Supplies & Equipment: Items like wheelchairs, walkers, hospital beds (80% coverage, you pay 20%)
Eligibility Requirements for Part B Home Health
To qualify for Medicare Part B home health coverage, you must meet ALL four of these conditions:
Doctor's Order
A doctor must determine you need home health care and create a plan of care
Homebound Status
You have difficulty leaving home without considerable effort. Absences for medical treatment, religious services, or family events are allowed.
Skilled Care Needed
You require skilled nursing, physical therapy, or speech therapy on an intermittent basis
Medicare-Certified Agency
The home health agency must be certified by Medicare
When Part A Covers Home Health Care
Medicare Part A only covers home health care in these specific situations:
- You're receiving home health care within 14 days of a qualifying hospital or skilled nursing facility stay
- The home health care is for the same condition you were treated for in the hospital
- You still need skilled nursing or therapy services
Important:
If Part A covers your home health care, you don't need to also have Part B coverage. However, if you need ongoing care after the Part A benefit ends, Part B will take over—assuming you meet the eligibility criteria.
What Medicare Does NOT Cover
Neither Part A nor Part B Covers:
- 24-Hour Care: Round-the-clock nursing or custodial care
- Meals Delivered to Your Home (e.g., Meals on Wheels)
- Homemaker Services: Shopping, cooking, laundry (unless part of skilled care plan)
- Custodial/Personal Care Only: If you don't need skilled care
- Prescription Drugs: (covered under Part D)
Cost Breakdown: What You Pay
Under Medicare Part B:
- Home Health Visits: $0 (100% covered)
- Medical Equipment: You pay 20% after Part B deductible ($240 in 2024)
- Part B Premium: $174.70/month in 2024 (varies by income)
Under Medicare Part A:
- Home Health Visits: $0 (100% covered)
- Part A Premium: $0 for most people (if you or your spouse paid Medicare taxes for 10+ years)
Maximizing Your Medicare Home Health Benefits
1. Get a Clear Doctor's Order
Ensure your physician documents your homebound status and need for skilled services
2. Choose a Medicare-Certified Agency
Verify the agency's Medicare certification status before starting care
3. Understand "Intermittent" Care
"Intermittent" means fewer than 7 days per week or less than 8 hours per day over a 21-day period
4. Document Your Homebound Status
Keep records of why leaving home is difficult (mobility aids, safety concerns, medical conditions)
5. Appeal If Denied
If Medicare denies coverage, you have the right to appeal within 120 days
Common Medicare Home Health Scenarios
Scenario 1: Post-Surgery Recovery
You had hip replacement surgery and need physical therapy at home.
Coverage: Part A covers for 14 days post-discharge, then Part B continues coverage as long as you're homebound and need skilled therapy.
Scenario 2: Chronic Condition Management
You have diabetes and need a nurse to manage wound care and insulin.
Coverage: Part B covers skilled nursing visits and supplies as long as you're homebound.
Scenario 3: Stroke Recovery
You've had a stroke and need speech, physical, and occupational therapy.
Coverage: Part B covers all three therapies simultaneously, plus home health aide services during therapy sessions.
Verify Your Medicare Coverage
Not sure if your situation qualifies for Medicare home health coverage? We'll review your Medicare benefits, verify coverage, and help you navigate the approval process—at no cost to you.
Medical Disclaimer: This article is for informational purposes only and does not constitute medical or legal advice. Medicare coverage rules can change. Always verify your specific coverage with Medicare or your healthcare provider.