Hello!

Medicare covers home health care (medical or clinical care) if the beneficiary meets Medicare’s eligibility requirements, and said care is necessary to treat an illness or injury.

Many treatments that used to require a hospital or doctor’s office can now be done at home. Home health care is often more affordable, convenient, and just as effective.

The goal is to treat illnesses or injuries, support recovery, and help our patient regain independence. It can also maintain chronic conditions or slow decline when needed.

Medicare beneficiaries may be eligible for home health care if the following conditions are met:

• They are under the care of a doctor or other health care provider (including a nurse practitioner, a clinical nurse specialist, and physician assistant), and receiving health services as part of a care plan that a doctor or allowed provider established and reviews regularly.
• They have chosen a home health agency that is Medicare-certified.
• Their doctor or allowed provider certifies that a need for one or more of these services:
  • Intermittent skilled nursing care (other than drawing blood)
  • Physical therapy
  • Continued occupational therapy
  • Speech-language pathology services
  • Home health aide services (HHA)
  • Medical social worker services
• Their doctor or allowed provider certifies that the beneficiary is homebound and documented through face-to-face encounter (like an appointment with primary care doctor) within the required timeframes and that the encounter was related to the reason home health care is needed.
  To be homebound means: 
• They have trouble leaving the home without help (like using a cane, wheelchair, walker, or crutches; special transportation; or help from another person) due to illness or injury, or leaving the home isn’t recommended because of their condition.
• They are normally unable to leave home, but if they do, it requires a major effort.
• They may leave home for medical treatment or short, infrequent absences for non-medical reasons, like an occasional trip to the barber, a walk around the block, or attendance at a family reunion, funeral, graduation, or other infrequent or unique event. They can still get home health care if they attend adult day care or religious services.

Non-eligibility occurs If the medical need is more than intermittent skilled nursing care. Medicare defines “intermittent” as skilled nursing care that’s needed.

• Fewer than 7 days each week
• Daily for less than 8 hours each day for up to 21 days. Medicare may extend the three-week limit in exceptional circumstances as long as the care needs are predictable and temporary.
• Medicare does not cover full-time skilled nursing care over an extended period. Such services would need to be covered by private pay, an additional insurance provider or long-term insurance.

Note: Medicare will not cover home health care if they only need occupational therapy. However, if the qualify for other home health services, they can also receive occupational therapy. When other care ends, occupational therapy may continue to be covered under Medicare’s home health benefit if you still need it.