Home healthcare can include many different services that are delivered to you in your home. Medicare will cover some of your home healthcare needs, however you will need to meet certain stringent conditions to be eligible for the coverage.
Services covered by Medicare’s home health benefit include intermittent skilled nursing care, some skilled therapy services as well as care provided by a home health aide.
To receive Medicare coverage, you will need to meet certain coverage criteria:
1- You will need to be homebound. Being homebound requires that you need extensive assistance as well as a lot of personal effort to leave your home. This translates by Medicare as that you need the help of another person or by medical equipment such as crutches, a walker or a wheelchair to leave your home, or if your doctor believes that your health or illness will decline if you leave your home.
Medicare does offer some flexibility. Medicare will allow you to leave your home and not be disqualified in order for you to receive medical treatment, attend religious services, and/or to attend a licensed or accredited adult day care center. It will also allow you to leave your home for short periods of time for special non-medical events like funerals or a graduation.
2- You need skilled nursing services and/or skilled therapy care on an intermittent basis. Skilled therapy services include physical, speech and occupational therapy (Note that you cannot qualify for Medicare home health coverage if you only need occupational therapy. However, you can receive occupational therapy if you also need and qualify for other home healthcare therapy).
Intermittent means that 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 to be predictable and finite.
Medicare defines skilled care as care performed by a skilled professional or under their supervision.
3- You have a face-to-face meeting with a doctor within 90 days before starting your home healthcare, or within 30 days after you first receive care. The face-to-face meeting can include an office visit, a hospital visit and under certain circumstances a telemedicine visit.
Your doctor must sign a home health certification confirming that you are homebound and need intermittent skilled care. The certification must state that the doctor approves the care plan and that the face-to-face requirement has been met.
This plan will need to be reviewed and recertified every 60 days.
4- You will also need to receive your care from a Medicare-certified home health agency (HHA).
If you meet all of these requirements, Medicare should cover you for skilled care in your home. Some of these requirements are complex and they can change. Do not rely on this webpage as there could be errors and accidental omissions. Also, the laws and regulations do change. Always reconfirm this information, talk with your doctor and your Medicare Certified Home Health Agency. You can also reconfirm and ask questions by calling Medicare at 1-800-MEDICARE.