Home health care covers a wide range of health care services that you can get in your home for an illness or injury. It’s more convenient, typically less expensive, and usually just as effective as care you get in a hospital or skilled nursing facility (SNF).
Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance) cover eligible home health services as long as you need part-time or intermittent skilled services and you’re “homebound”. This means that you are unable to leave your home without major effort because of a condition, or without help, for example, without the use of a cane, crutches, a walker, wheelchair, special transportation, or help from another person, because of an injury or illness. A doctor or other healthcare provider must first evaluate you in person and then certify that you need home health services. They must order your care, and care must be provided by a Medicare-Certified Home Health Agency. They should provide you with a list of local agencies and tell you whether they have a financial interest in any of them. The Agency will update your doctor about your progress.
Covered home health services include medically necessary part-time or intermittent skilled nursing care for things like
Intravenous or nutrition therapy or Injections
Wound care for pressure sores or surgical wound
Monitoring serious illness and unstable health status
Medical social services, Patient and caregiver education
Physical or Occupational therapy, Speech-language pathology services
Medicare doesn't pay for 24-hour-a-day care at your home, home meal delivery, Homemaker Services (like shopping and cleaning) unrelated to your care plan or help with ADL’s (Activities of Daily Living), like walking, bathing or grooming, feeding, toileting, when this is the only care you need. Home health aide care, like help with ADL’s, is only covered if you are first also receiving covered home health services.
In most cases, "part-time or intermittent" means you may be able to get skilled nursing care and home health aide services up to 8 hours a day (combined), for a maximum of 28 hours per week. You may be able to get more frequent care for a short time (less than 8 hours each day and no more than 35 hours each week) if your provider determines it's necessary. If you need more than part-time or "intermittent" skilled care you won't qualify for the home health benefit. Rules allow for leaving home for medical treatment or short, infrequent absences for non-medical reasons, like attending religious services. You can still get home health care if you attend adult day care.
Your costs in Original Medicare
$0 for covered home health care services.
After you meet the Part B deductible, 20% of the Medicare-approved amount for Medicare-covered medical equipment.
Before you start getting your home health care, the home health agency should tell you how much Medicare will pay. The agency should also tell you (both verbally and in writing) if Medicare won't pay for any items or services they give you, and how much you'll have to pay for them. The home health agency should give you a notice called the ABN (Advance Beneficiary Notice) before giving you services and supplies that Medicare doesn't cover.
If you get your Medicare benefits through a Medicare Advantage Plan (Part C) or another Medicare health plan, check with your plan for more information about your home health benefits. If you have a Medicare Supplement Insurance (Medigap) policy or other health insurance coverage, tell your doctor or other provider so your bills get paid correctly.
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