Home Health Care includes a wide range of health and social services delivered in your home to treat illness or injury. Services covered by Medicare’s home health benefit include intermittent skilled nursing care, therapy, and care provided by a home health aide A home health aide provides personal care services for a patient at home, including help with bathing, toileting, and dressing. Medicare pays in full for an aide if you require skilled care (skilled nursing or therapy services) and meet other requirements. Medicare will not pay for an aide if you only require personal care and do not need skilled care. . Depending on the circumstances, home health care will be covered by either Part A or Part B.
Medicare covers your home health care if:
- You are homebound, meaning it is extremely difficult for you to leave your home and you need help doing so.
- You need skilled nursing services and/or skilled therapy care on an intermittent basis.
- Intermittent means you need care at least once every 60 days and at most once a day for up to three weeks. This period can be longer if you need more care, but your care needs must be predictable and finite.
- Medicare defines skilled care as care that must be performed by a skilled professional, or under their supervision.
- Skilled therapy services refer to physical, speech, and occupational therapy Occupational therapy is therapy that helps you regain the ability to do usual daily activities by yourself, such as eating and putting on clothes. .
- You have a face-to-face meeting with a doctor within the 90 days before you start home health care, or the 30 days after the first day you receive care. This can be an office visit, hospital visit, or in certain circumstances a face-to-face visit facilitated by technology (such as video conferencing).
- Your doctor signs a home health certification confirming that you are homebound and need intermittent skilled care. The certification must also state that your doctor has approved a plan of care for you and that the face-to-face meeting requirement was met.
- Your doctor should review and certify your home health plan every 60 days. A face-to-face meeting is not required for recertification.
- And, you receive care from a Medicare-certified Medicare-certified means offering services at a level of quality approved by Medicare. Medicare will not pay for services received from a health care provider that is not 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. .
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.
If you meet all the requirements, Medicare should pay for skilled care in your home and/or home health aide services. If you have questions or experience billing issues, call 1-800-MEDICARE.