Does a health condition prevent you from traveling to and from some of your medical or rehab therapy appointments? You may qualify for the Medicare home health care benefit.
Medicare coverage for home health care
Home health care is for someone who needs to receive skilled nursing care or rehab therapy in their own home. Without home health care, some individuals may not get the health care they need.
Medicare may cover the following services and items for those who qualify for the benefit.
- Part-time or intermittent skilled nursing care. Care must be provided by or under the supervision of a professional registered nurse. (Examples of skilled nursing care include injections, tube feeding and catheter changes.)
- Physical, speech or occupational therapy.
- Durable medical equipment (DME) and supplies, such as a hospital bed for use at home.
Medicare beneficiaries who receive any part of the home care benefit may also be eligible to receive additional services, including:
- Medical social services, such as counseling or resources to help with the health condition
- A home health aide to help with activities of daily living like bathing and dressing
Home health care eligibility requirements
You may qualify for home health care if you meet the following qualifications.
- You require one of these in-home services:
- Part-time or intermittent skilled nursing care
- Physical, speech or occupational therapy
- Durable medical equipment for your use at home
- You are under the care of a doctor and receive your home health services under a plan of care reviewed regularly by a doctor.
- The home health care provider is Medicare-approved.
- You are “homebound”, and your doctor certifies that you are homebound. Homebound means:
- You have a health condition that makes it difficult and possibly harmful if you try to leave the home.
- Leaving your home takes a considerable and taxing effort.
- You need special transportation, the help of another person, or a wheelchair, cane, walker or other assistive device in order to leave your home.
You may be allowed to leave your home for medical appointments and occasional religious services or adult day care and still qualify for home health care.
Medicare coverage for home health care
Medicare Part A and Part B cover home health care. Medicare generally covers all the costs for most covered skilled nursing services; physical, speech and occupational therapy sessions; and sometimes home health aide services.
Medicare pays 80 percent for durable medical equipment (DME) and osteoporosis drugs that are furnished as a home health service. You pay the other 20 percent if the DME provider accepts Medicare payment as payment in full. If the provider doesn’t accept Medicare payment as payment in full, you may have to pay the other 20 percent plus an extra 15 percent of the costs for your DME.
If your health care provider orders any services, items or extra visits not covered under the Medicare home health care benefit, you may have to pay for all or part of the costs.
Before you use a service, item or visit, always ask if it’s covered by Medicare and if you’ll have to pay any portion of the cost.
Find a home health care provider
You can search for a provider by using the online home health care provider tool at Medicare.gov. Just enter your zip code and the tool will give you a list of home health care providers in your area. You can also ask your doctor, hospital social worker or discharge administrator to arrange for a home health provider in the event you need home care after a hospital stay.
Don’t let an injury or illness prevent you from getting the help you may need. Talk to your doctor and ask if you qualify for home health care.
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