The Basics of Home Health

Home health care includes a wide range of health and social services delivered in your home to treat illness or injury. Services covered include intermittent skilled nursing care, therapy, and care provided by a home health aide. Home health care will still depend on the circumstances, thus, it will be covered by either Part A or Part B.

Medicare will cover your home health care if:

You are homebound, which means that it is extremely difficult for you to leave your home and you need help in doing so.
You need skilled nursing services and/or skilled therapy care on an intermittent basis.
You have a face-to-face meeting with a doctor within the 90 days before you start home health care, or the 30 days after the first day you receive care. This can be an office visit, hospital visit, or in certain circumstances a face-to-face visit facilitated by technology (such as video conferencing).
And, you receive care from a Medicare-certified home health agency (HHA).

Definition of terms:

Intermittent means 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 must be predictable and finite.

Medicare defines skilled care as care that must be performed by a skilled professional, or under their supervision.

Skilled therapy services refer to physical, speech, and occupational therapy.

Note:

Your doctor signs a home health certification confirming that you are homebound and need intermittent skilled care.

The certification must also state that your doctor has approved a plan of care for you and that the face-to-face meeting requirement was met.

Your doctor should review and certify your home health plan every 60 days. A face-to-face meeting is not required for recertification.

You cannot qualify for Medicare home health coverage if you only need occupational therapy. However, if you qualify for home health care on another basis, you can also get occupational therapy. When your other home health needs end, you can continue receiving Medicare-covered occupational therapy under the home health benefit if you need it.

If you meet all the requirements, Medicare will pay for skilled care in your home and/or home health aide services.

If you have questions or experience billing issues, call 1-800-MEDICARE.

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