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Home Health Care

August 9, 2018

Medicare Coverage of Home Health Services

Home health care includes a wide range of services delivered in your home by a home health agency to treat an illness or injury. Home health services eligible for Medicare coverage include:

  • Skilled nursing services: Services performed under the supervision of a licensed or certified nurse.
  • Skilled therapy services: Physical, speech, and occupational therapy that is reasonable and necessary to treat your illness or injury, and is performed by or under the supervision of a licensed therapist.
  • Home health aide: A home health aide provides personal care services, including help with bathing, toileting, and dressing. Medicare will not pay for an aide if you only need personal care and do not need skilled care in the first place.
  • Medical social services: Services ordered by your doctor to help you with social and emotional concerns you have related to your illness.
  • Medical supplies: Certain medical supplies, including wound dressings and catheters, when provided by a Medicare-approved home health agency.
  • Durable Medical Equipment (DME): Medicare pays 80% of its approved amount for certain pieces of medical equipment, such as a wheelchair or walker.

Home health services  NOT COVERED BY MEDICARE include:

  • 24-hour home care
  • Prescription drugs (These are covered by Part D and some Medicare Advantage plans.)
  • Home meal delivery
  • Housekeeping services

Medicare will cover your home health care services if:

  1. You are homebound, meaning you cannot leave your home without “considerable and taxing effort.”
  2. You need skilled nursing services intermittently and/or skilled therapy.
    • Skilled care= care performed by or under the supervision of a skilled professional
    • Intermittent= at least once every 60 days but no more than once a daily for three weeks. This period can sometimes be longer under certain circumstances, as long as your needs are predictable and finite.
    • Skilled therapy= physical, speech, and occupational therapy. NOTE: Occupational therapy can only be covered if you qualify on another basis. It cannot be the sole reason for skilled therapy in the home.
  3. You have a face-to-face meeting with your doctor either within 90 days before initiating home health care or within 30 days after you begin receiving care.
  4. Your doctor signs signs a home health certification confirming that you are homebound, in need of intermittent skilled care, and that your doctor has approved a plan of care and met with you face-to-face.
  5. You receive your care from a Medicare-approved home health agency.