Home Doctor Visits: What Does Medicare Cover?

Since the beginning of the Covid-19 pandemic, patients have been hesitant to schedule in-person doctor visits ­– hence the increase in telehealth and telemedicine services. Yet, there are many conditions, services, and treatments for which virtual appointments are far from ideal.

Medicare beneficiaries may have Covid-related anxieties regarding face-to-face appointments in a medical setting, because of their higher risk. This begs the question: Does Medicare cover home doctor visits?

Before you try to figure out whether Medicare will cover a home doctor visit, you’ll need to know which doctors you can visit with your coverage. When you have Original Medicare (Parts A and B), with or without a Medicare Supplement (Medigap) policy, you’ll have coverage for any practitioner accepting Medicare assignment. Fortunately, most doctors in the United States accept the coverage.

With a Medicare Advantage (Part C) plan, you’ll need to stick to your policy’s network of doctors to receive coverage for any care you receive. Additionally, you’ll require referrals for coverage through your plan when seeing any specialist. Part C includes the coverage Parts A and B provide, which are inpatient and outpatient services, respectively.

Unfortunately, Medicare doesn’t typically cover the type of house calls with which people are most familiar. Even in the age of Covid, it’s not as simple to make an appointment for a home visit from your primary care physician as it is to schedule a telehealth visit.

Ultimately, Medicare will pay for you to receive care at home (home health care) if your circumstances qualify you for such. Again, you’ll need to make sure your provider accepts Medicare assignment (if you have Original Medicare) or is within your Advantage plan’s network for your care to receive coverage. This rule of thumb applies regardless of whether the care will take place at your home.

Medicare’s guidelines for home health care dictate that the visit must be medically necessary. Thus, you must be under the care of a doctor for your condition(s) and your doctor deems certain at-home care to be a necessity.

You must qualify as homebound, meaning you have difficulty leaving your home independently (i.e., without the use of an assistive device, such as a cane). Further, your practitioner must document a face-to-face meeting with you to verify your eligibility.

An eligible individual can receive physical, speech, or occupational therapy, or intermittent care from a skilled nursing professional at home. The practitioner providing the service must accept Medicare assignment or contract with your Advantage plan.

In 2011, the Centers for Medicare & Medicaid Services (CMS) launched a program called the Independence at Home Demonstration. It is a voluntary, primary care program for patients with multiple chronic conditions who are still living independently but would benefit from a doctor’s visit at home. Yet only an extremely limited number of sites across the country participate in the model.

The program has resulted in savings for CMS. While the program was supposed to end at the close of 2020, it is now extended through the end of 2023. If further success results from this endeavor, Medicare may see changes regarding this type of care.

Hesitancy to attend in-person medical appointments due to possible Covid-19 exposure increases the need for alternative options. While Medicare now includes more coverage for telehealth than ever, the same cannot be said for house calls.

When an individual needs a face-to-face appointment with their primary provider to determine necessity for home health care, it’s clear that coverage is far from comprehensive. With the need to fill this gap in coverage and the success of the Independence at Home Demonstration, Medicare will hopefully see more coverage for primary care house calls – including routine check-ups – in the future. The health of beneficiaries depends on it.

How often have you visited your doctor’s office in the past year and a half? How often have you used telehealth services? Would you ask for a home doctor visit if it were available? How would that help you?


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