There are specific conditions that should be met in order Medicare to cover Home Health Care. Read below about the list of requirements and description of what Medicare will pay for. For more information, read the following CMS publication Medicare and Home Health Care.
When will Medicare cover Home Health Care?
In order Medicare to cover Home Health Care, the following list of requirements should be met:
- You must be homebound, i.e.
- You have trouble leaving your home without help because of an illness or injury, AND
- Leaving your home isn’t recommended because of your condition, and you are normally unable to leave your home because it’s a major effort
- You must require part-time or intermittent skilled nursing care, and/or physical therapy, speech pathology services, or occupational therapy
- A doctor must see you face-to-face and certify your need for home health services
- The home health care must be provided by a Medicare-certified home health agency. You may find a list of home health care agencies in your area on Medicare.gov
The recent changes allow you to qualify for home health care just to maintain your condition and to prevent your health from getting worse, not necessarily to improve it.
What will Medicare cover?
Medicare Part A pays 100% of your covered home health care, and there is no limit on the number of visits to your home that Medicare will pay for. If you require a durable medical equipment, Medicare will pay 80% of the costs.
The following home health care services are covered:
- Part-time skilled nursing care (usually 2-3 visits per week)
- Physical therapy
- Speech therapy
- Occupational therapy
If your home health care include skilled nursing care, Medicare will also pay for home health aide services (e.g. help with bathing, dressing, and using the bathroom). Otherwise, Medicare will not pay for home health aide services.
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