Does Medicare cover home health care?

Yes, Medicare provides some coverage for home health care, but you must meet specific criteria, particularly if you’re mostly or entirely confined to your home. Medicare will cover part-time or intermittent skilled nursing care, therapy and other aid that’s determined to be medically necessary and that your doctor orders.

But Medicare won’t pay for care to help you with activities of daily living, such as bathing, dressing, eating or going to the bathroom if that’s the only care you need.

How do I qualify for Medicare home health benefits?

For you to be eligible for home health benefits, Medicare must approve the home health agency providing care and you must:

• Be homebound. That means you’re unable to leave home without considerable effort, the aid of another person or a device such as a walker or wheelchair.

• Have certification from a physician or other health care provider, such as a nurse practitioner, identifying that you need intermittent occupational therapy, physical therapy, skilled nursing care and/or speech-language therapy. This certification entails a documented face-to-face encounter with a doctor or medical professional occurring no more than 90 days before or 30 days after the start of your home health care.

• Be under a plan of care that a doctor or other health care provider establishes and reviews regularly. That plan should note all services needed and how often, which health care professionals should give the services, required supplies and the results your doctor anticipates. The doctor and home health team must review and recertify the care plan at least once every 60 days.

What Medicare home health benefits are available?

If you qualify for home health benefits, Medicare may cover the following services:

• Home health aides to help with personal activities such as bathing, dressing or going to the bathroom, if such help is necessary because of your illness or injury. Medicare covers these services only if you’re also receiving skilled nursing or therapy.

• Medical social services, like counseling for social or emotional concerns related to your illness or injury if you’re receiving skilled care. It also covers help in finding community resources if you need them.

• Occupational, physical and speech therapy with professional therapists to restore or improve your ability to perform everyday tasks, speak or walk after an illness or injury, or to prevent your condition from getting worse.

• Skilled nursing care on a part-time or intermittent basis that requires more active care, such as changing wound dressings, assisting with feeding and injecting medicine through a feeding tube. Medicare stipulates the care must be provided fewer than seven days each week or daily for less than eight hours each day for up to 21 days.