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Home Health CareMedicare and Home Health Care

Medicare can help pay for health care services in your home. How you might qualify for the Medicare home health benefit.

Medicare can help pay for your home health care.

 

It must be part-time or "intermittent" care
If you meet the eligibility criteria and you require only part-time or "intermittent" skilled nursing care, you probably qualify to have Medicare pay for your covered home health services.

To decide if you're eligible, Medicare defines part-time or "intermittent" as skilled nursing care on less than 7 days each week or less than 8 hours each day over a period of 21 days (or less). There are some exceptions in special circumstances.

Here is a brief summary of the other criteria:
  • You must be under a doctor's continuing care
  • You must need, and a doctor must certify that you need, one or more of the following: Intermittent; skilled nursing care; Physical therapy; Speech-language pathology services; and/or Continued occupational therapy
  • The home health agency you choose must be approved by Medicare
  • You must be homebound, and a doctor must certify that you're homebound.
For a detailed explanation of Medicare home health benefit eligibility, see the booklet Medicare and Your Home Health Benefits at the Medicare.gov website. (The booklet is in Adobe .pdf format and requires the Adobe Acrobat Reader.) Call 1-800-MEDICARE (1-800-633-4227 to get the most current information.

What does "homebound" mean?
Homebound, in common usage, means someone who is unable to leave their home. Medicare, however, has a more specific definition. (from Medicare and Your Home Health Benefits, http://medicare.gov)

"To be homebound means the following:
-Leaving your home isn't recommended because of your condition.
-Your condition keeps you from leaving home without help (such as using a wheelchair or walker, needing special transportation, or getting help from another person).
-Leaving home takes a considerable and taxing effort."

You are allowed to leave home for medical treatment, or make short trips away for other reasons such as religious services. You can also get Medicare's Home Health Care benefit while you are enrolled in Adult Day Care, but you must get your health care services at home.

The 60 Day limit.
If you are covered under Original Medicare, Medicare pays your Home Health Care Agency for care during a 60-day period. The payment is based on your treatment and needs.

Other medical services, such as care from your doctor, are covered under your other Medicare coverage.

What will Medicare pay for?
In brief: skilled nursing care; physical therapy, occupational therapy, and speech-language pathology services. Also Medical social services and medical supplies, subject to conditions.

Durable Medical equipment, such as walkers and wheelchairs ordered by a physician, are covered under different Medicare coverage. (See the reference above to the Medicare and Your Home Health Benefits booklet for details about what Medicare pays for.)

What will Medicare NOT pay for?
Here are a few examples: 24-hour care; home-delivered meals; personal care assistance or homemaker services like toilet help, bathing, and getting dressed when this type of help is all you need. You may be billed for other services.

Medicare Certified Home Health Care Agencies
If you plan on using Medicare to help pay for costs, you must choose an agency from the Medicare-certified home health agencies that serve your area. Most of our directories for each state, county and city clearly identify which agencies are Medicare certified.

For more information: What "Medicare Certified" Means



 
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