Many people wonder if Medicare will cover Home Health Services. The good news is yes, Medicare will cover services that were once only offered only in a hospital or a doctor’s office.
Before Medicare will cover health care services in your home you must meet certain Medicare criteria and the services must be considered reasonable and necessary for your specific injury or illness.
You are Eligible for Medicare Home Health Care If:
- You are homebound: You cannot leave your home without help, considerable effort, or using a device such as a cane, wheelchair, or walker.
- You are certified by a doctor or other medical professional who works with a doctor as needing skilled services, such as skilled therapy or nursing services on an intermittent basis
- Medicare Certified: The home health agency that is providing your home health care is approved by Medicare.
- Doctor certification: your Medicare certification of eligibility must be documented by a doctor or other health care professional who works with a doctor (like a nurse practitioner), and that they’ve had a face-to-face encounter with you no more than 90 days before care or 30 days after the start of home health care.
Covered Home Health Care Benefits
- Skilled nursing care: This includes giving IV drugs, certain injections or tube feedings, and changing dressings.
- Physical therapy, occupational therapy: Work with a skilled therapist to establish a program and/or perform therapy under a maintenance program to help you maintain your current condition or to prevent your condition from getting worse.
- Home health aide services: Medicare will pay for home health aide services (like personal care) if needed to treat your illness or injury. Medicare will not cover home health aide services unless you are also getting skilled nursing or therapy care.
Medicare will not Cover
- Meals delivered to your home
- Homemaker services, like shopping, cleaning, and laundry
- 24-hour care at your home
- Custodial or personal care like bathing, dressing, and using the bathroom when this is the only care you need
The combined personal care and home nursing care may not exceed eight hours a day or 28 hours for a week (up to 35 hours a week in some limited situations). If you need full-time care, you probably will not qualify for home health benefits.
This article applies to people who have Original Medicare or Original Medicare along with a Medigap (Medicare Supplement) plan. If you are enrolled in a Medicare Advantage plan, check with your plan provider for details about how the plan provides your Medicare-covered home health services.
Download the Medicare & Home Health Care Booklet
This article is only a brief overview of the coverage of Medicare and Home Health Care. For more information, you can read or download the official Medicare & Home Health Care Booklet by clicking on the link. Medicare and Home Health Care Booklet
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