If you meet Medicare’s home health eligibility requirements, Medicare should cover your care regardless of whether your condition is temporary or chronic. Medicare covers skilled nursing and therapy services as long as they:
- Help you maintain your ability to function
- Help you regain function or improve
- Or, prevent or slow the worsening of your condition
Providers and agencies may worry that Medicare will not cover skilled home care if you are no longer showing signs of improvement. However, Medicare should not deny your home care because your condition is chronic or unchanging, or when additional care will not improve your ability to function—as long as the care is medically necessary Medically necessary refers to procedures, services, or equipment that meet accepted medical standards and are necessary for the diagnosis and treatment of a medical condition. to maintain your condition or to prevent or slow deterioration.
If you have chronic care needs, it may be hard to find a home health agency (HHA) A home health agency (HHA) is an organization that provides home care services, such as skilled nursing, physical therapy, occupational therapy, speech-language pathology, and personal care. willing to provide you with services. If you have Original Medicare Original Medicare, also known as Traditional Medicare, is the fee-for-service health insurance program offered through the federal government, which pays providers directly for the services you receive. Almost all doctors and hospitals in the U.S. accept Original Medicare. , call 1-800-MEDICARE for a list of HHAs in your area. If you have a Medicare Advantage Medicare Advantage, also known as Part C, Medicare Private Health Plan, or Medicare Managed Care Plan, allows you to get Medicare coverage from a private health plan that contracts with the federal government. All Medicare Advantage Plans must offer at least the same benefits as Original Medicare (Part A and Part B), but can do so with different rules, costs, and coverage restrictions. Plans typically offer Part D drug coverage as part of Medicare Advantage benefits. Medicare Advantage Plans include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service (PFFS) plans, Special Needs Plans (SNPs), and Medicare Medical Savings Accounts (MSAs). Plan, contact your plan for a list of in-network HHAs.