When Medicare pays for home health care
Section IV.f. Home Health Care Benefit (Part A and B)
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Home care is a phrase commonly used to refer to a wide range of health and social services. These services are delivered at home to recovering, chronically or terminally ill persons or people with disabilities in need of medical, nursing, social or therapeutic treatment, and/or assistance with the essential activities of daily living.
Medicare will help pay for your home care if all four of the following are true:
1. You are considered homebound. Medicare considers you homebound if you meet the following criteria:
2. You need skilled care. This includes skilled nursing care on an intermittent basis. Intermittent means you need care little as once every 60 days to as much as once a day for three weeks (this period can be longer if you need more care but your need for more care must be predictable and finite). This can also mean you need skilled therapy services. Skilled therapy services can be physical, speech or occupational therapy;*
3. Your doctor signs a home health certification stating that you qualify for Medicare home care because you are homebound and need intermittent skilled care. The certification must also say that a plan of care has been made for you, and that a doctor regularly reviews it. Usually, the certification and plan of care are combined in one form that is signed by your doctor and submitted to Medicare.
4. You receive your care from a Medicare-certified home health agency (HHA).
*If you only need occupational therapy, you will not qualify for the Medicare home health benefit. However, if you qualify for Medicare coverage of home health care on another basis, you can also get occupational therapy. Even when your other needs for Medicare home health end, you should still be able to get occupational therapy under the Medicare home health benefit if you continue to need it.
If you have questions about billing issues for home health care you should contact 800-MEDICARE.