Will Medicare Pay for Hospital-Level Care at Home?

When people need skilled nursing care or therapy, most families think a nursing home is their only option. However, Medicare covers hospital-level care at home for qualifying patients. In-home care allows patients to continue living with their loved ones and to stay in their community. Home health care services generally cost less and improve patients’ quality of life.

There are strict requirements for Medicare’s home health care benefits. To receive home health benefits, contact an elder law attorney to learn about eligibility requirements.

Who Qualifies For Medicare’s Home Health Benefits

Medicare’s home health services are available for qualifying homebound patients. To qualify, patients must need part-time or intermittent skilled nursing care.

The patient’s doctor must certify that the patient is homebound. This includes people who cannot leave their home without difficulty, such as those who use a wheelchair, require special transportation, or need help from another person. Homebound patients also include those who do not leave their home because it is a major effort, or it is not recommended because of their condition.

Unlike long-term nursing home care, there are no asset and income requirements for home health care for homebound patients.

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Qualifying Home Health Care Services

Qualifying home health services include any medically necessary nursing care, including wound care, IV therapy, and monitoring of serious illnesses. Other covered home health aide services include:

• Durable medical equipment
• Medical social services
• Occupational therapy
• Physical therapy services
• Speech-language pathology services

Medicare generally covers 100 percent of the above care costs. There may be a percentage cost for medical supplies after meeting the Medicare Part B deductible. However, home care does not pay for uncovered services, such as meal delivery, homemaker services, or personal care.

Who Can Provide In-Home Care

Hospital-level care services are not for things your spouse, family members, or friends can do. Home health care is not for meal preparation, 24-hour day care, or helping you with activities of daily living.

A health care provider must give you an in-person assessment to determine what level of care you need. You must get your treatment from a Medicare-certified home health agency. In-home care providers may include registered nurses, skilled therapists, and home health aides.

Home Health Care Plans

Your doctor, health care team, and home health agency will create a care plan for the services, treatments, and visits that will take place in your home. The plan of care is based on your individual needs, including:

• Types of medical services
• Health care providers involved
• Monitoring requirements
• How often you require services/visits
• Medical equipment and supplies

The home health team may also work with your family members and home caregivers about your care and conditions. Your team will monitor your results and share them with your health care provider. Your plan may change as your team reviews your case. If you have issues or concerns, talk to your doctor, health care provider, or home health agency.

Does My Medicare Plan Cover Home Care Needs?

All Medicare programs should cover qualifying home health care. This includes original Medicare (Parts A and B) or Medicare Advantage (Part C). However, some Medicare Advantage plans may cover additional home care services.

In most cases, Medicare pays 100 percent of the cost of medically necessary home health care. However, you may need prior authorization to make sure the home care is a covered service.

Talk to your home health agency about how much Medicare will pay, any partial costs, and deductibles. The agency should provide an Advance Beneficiary Notice to inform you of any uncovered costs.

Medicare’s Acute Hospital Care at Home Waiver

Medicare’s Acute Care Hospital at Home (ACHAH) program allows hospitals to provide acute care at the patient’s home. The program was first developed during the COVID-19 pandemic in 2020. Congress has continued to extend the program, with the latest extension running through 2030.

Hospitals must apply for ACHAH participation. ACHAH grants them a waiver from certain Medicare requirements, such as 24-hour on-site nursing care. Hospitals still have to meet strict acute care regulations, including:

• Two in-person clinical visits per day
• 24/7 contact availability
• Monthly reporting
• Dispatch clinical health care providers within 30 minutes

Find a Lawyer For Help With Hospital Care at Home

Most patients want to stay in their own home and avoid moving into a long-term care or skilled nursing facility. Home health aide services provide important care that would normally require an inpatient hospital stay.

You can find more information about home health services on the Centers for Medicare & Medicaid Services (CMS) website. An attorney can also explain the benefits of home health care and how you can qualify.

For legal advice about qualifying for hospital-level care at home, talk to a local elder law attorney.