Medicare Coverage for Home Health CarePosted by Medicare Made Clear
Home health care can provide a variety of services to help you recover from an illness or injury and regain your independence. Care provided in the home is generally less expensive and more convenient than care received in the hospital or a skilled nursing facility (nursing home).
Coverage and Cost
Medicare Part A covers home health care under certain conditions. You must be under the care of a doctor who has established your care plan and who reviews it regularly. Your doctor must certify that you need one or more of the following:
Intermittent skilled nursing care (surgical wound care, intravenous therapy, etc.)
Speech-language pathology services
Continued occupational therapy
You must receive home health care services from a Medicare-certified home health agency. In addition, your doctor needs to certify that you are homebound, which means:
Leaving your home isn’t recommended because of your condition.
You need help to leave home (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 may leave home for medical treatment or occasionally for non-medical reasons, such as attending religious services. You may also attend adult day care.
If you get your Medicare benefits through a Medicare Advantage plan, call the plan to find out how it provides covered home health care benefits.
What to Expect
Once your doctor refers you for home health care services, the home health agency will schedule an appointment and come to your home. They will talk to you about your needs and ask you some questions about your health. They will also talk with your doctor about your plan of care.
Home health care professionals are responsible for coordinating your care. They regularly communicate your health status and treatment progress to you and your doctor, other health professionals you may be seeing and other caregivers.
It’s important that you receive the amount and type of care your doctor established in your care plan. In addition to nursing care and certain therapies, you may receive medical social services and medical supplies from the agency.
The home health agency may bill you for:
20% of the Medicare-approved amount for Medicare-covered medical equipment such as wheelchairs, walkers, and oxygen equipment.
Medical services and supplies that Medicare doesn’t pay for, but only when you agree to pay out of pocket for them. The home health agency should give you a Home Health Advance Beneficiary Notice before giving you services and supplies that Medicare doesn’t cover.
Home Health Care is Not Long-Term Care
Long-term care is a range of health and personal care services provided over months or years. It is generally not medical care as much as it is help with the tasks of everyday life, such as bathing and eating. These tasks are referred to as Activities of Daily Living (ADL). The service provided to assist with ADL is often called “custodial care.”
Usually, people receiving long-term care are not expected to recover their independence. Long-term care may be provided in the home, at an adult day care program or in an assisted care facility or nursing home.
For more information, contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048. If you have questions about Medicare Made Clear, call 1-877-619-5582, TTY 711, 8 a.m. – 8 p.m. local time, seven days a week.
MedicareMadeClear.com: Learn about Medicare and get tools to help with decision making.
Medicare.gov/homehealth: Find and compare Medicare-certified home health agencies in your area.