If you qualify for the home health benefit, Medicare covers the following:
- Skilled nursing services: Services performed by or under the supervision of a licensed or certified nurse to treat your injury or illness.
- Services you may receive include injections (and teaching you to self-inject), tube feedings, catheter changes, observation and assessment of your condition, management and evaluation of your care plan, and wound care.
- Provided up to seven days per week for generally no more than eight hours per day and 28 hours per week. In some circumstances, Medicare can cover up to 35 hours per week.
- Skilled therapy services: Physical, speech, and occupational therapy services that are reasonable and necessary for treating your illness or injury, and performed by or under the supervision of a licensed therapist.
- Physical therapy includes gait training and supervision of and training for exercises to regain movement and strength in a body area.
- Speech-language pathology services include exercises to regain and strengthen speech and language skills.
- Occupational therapy helps you regain the ability to do usual daily activities by yourself, such as eating and putting on clothes.
- Home health aide: Medicare pays in full for an aide if you require skilled care (skilled nursing or therapy services). A home health aide provides personal care services, including help with bathing, toileting, and dressing. Medicare will not pay for an aide if you only require personal care and do not need skilled care.
- Medical social services: Medicare pays in full for services ordered by your doctor to help you with social and emotional concerns you have related to your illness. This may include counseling or help finding resources in your community.
- Medical supplies: Medicare pays in full for certain medical supplies, such as wound dressings and catheters, when provided by a Medicare-certified 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. .
- Durable medical equipment (DME): Medicare pays 80% of its approved amount The approved amount, also known as the Medicare-approved amount, is the fee that Medicare sets as how much a provider or supplier should be paid for a particular service or item. Original Medicare also calls this assignment. See also: Take Assignment, Participating Provider, and Non-Participating Provider. for certain pieces of medical equipment, such as a wheelchair or walker. You pay 20% coinsurance The coinsurance is the portion of the cost of care you are required to pay after your health insurance pays. Usually, it is a percentage of the approved amount or negotiated amount. In Original Medicare, the coinsurance is usually 20% of Medicare’s assignment. (plus up to 15% more if your home health agency does not take assignment).
Medicare should pay for these services regardless of whether your condition is temporary or chronic.
Note: You cannot qualify for Medicare home health coverage if you only need occupational therapy. However, if you qualify for home health care on another basis, you can also get occupational therapy. When your other home health needs end, you can continue receiving Medicare-covered occupational therapy under the home health benefit if you need it.