Does Medigap Cover Home Health Care? Many treatments once only available in hospitals or doctor’s offices can now be administered at home. If you meet Medicare’s eligibility rules, Medigap will cover the costs. Find out more here.
What is Home Health Care?
Lots of medical care that used to be only available in hospitals or doctor’s offices can now be done at home. This is called home health care, and it’s usually cheaper, and equally effective as care received in a facility. The goal is to help you recover from an illness or injury, regain your independence, and become more self-sufficient. It can also help you maintain your current health or slow down any decline.
Medicare covers home health care if you meet certain requirements and if the services are medically necessary. If Medicare covers these services, Medigap plans will typically cover the remaining 20% of the costs. Those on certain Medigap plans, like G and N, may have to first satisfy the Part B deductible of $257 before Medigap pays for Home Healthcare.
Want to know more about Medigap plans? Check it out here.
Who is Eligible for Home Health Care?
If you meet the requirements for home health care under Medicare, Medigap will step in to cover the 20% that Medicare doesn’t, so you can get the full support you need:
Firstly, you need to be under the care of a doctor or approved provider who creates and regularly reviews a care plan for you.
Your doctor or provider must confirm you need one or more of these:
- Skilled nursing care (not including blood draws) on an intermittent basis
- Physical therapy
- Speech-language therapy
- Ongoing occupational therapy
- Home health aide services
Additionally, the home health agency providing your care must be Medicare-certified and must confirm you’re homebound, which means:
- You can’t leave your home without help (like a cane, wheelchair, or assistance from someone else) due to an illness or injury.
- Leaving home isn’t recommended for your condition or requires a significant effort.
- You can leave for medical treatment or brief non-medical outings, like a haircut or attending a special event.
Also, your doctor or provider must also document a face-to-face visit related to your need for home health care within the required timeframe.
When Medigap Doesn’t Cover Home Health Care?
We have established the Medigap can pay the 20% that Medicare doesn’t cover for Home Healthcare. When doesn’t Medigap pay for home health treatment. The simplest answer is: if Medicare doesn’t cover it, Medigap won’t either. So, let’s take a look at who isn’t eligible for Home Health Care. Medicare won’t cover home care if you need full-time skilled nursing for a long period. To qualify, nursing care must be provided fewer than seven days a week or less than eight hours daily for up to 21 days. Medicare may extend that limit in special cases, but it won’t cover services like meal delivery, household chores, or custodial care.
Important: If you have a Medigap policy, let your provider know so they can ensure proper billing. Don’t have a Medigap plan yet? No worries! Just give us a call at 800-930-7956 and we’ll be happy to help you find one that fits your needs, at no cost to you.