Medicare coverage: home health services

Home health services may provide the same quality care as a hospital or skilled nursing facility. These services may be less expensive and more convenient, too.1

Let’s look at some important details of home health services and Original Medicare.

Who’s eligible for home health services?

If you have Original Medicare (Part A and Part B), you may be eligible if:2

  1. You’re under the care of a doctor and get services under a plan of care created and reviewed by a doctor.
  2. You must need, and a doctor must certify that you need, 1 or more of these services:
    1. Intermittent skilled nursing care (other than drawing blood)
    2. Physical therapy
    3. Speech-language pathology
    4. Continued occupational therapy
  3. A doctor can certify that you’re homebound. This means your illness or injury causes you to have trouble leaving your home without using a cane, walker, crutches or wheelchair. Or, you require help from another person and/or need special transportation.
  4. The home health agency caring for you is approved by Medicare.

Note: If you need full-time skilled nursing care for a long time, it’s unlikely that you’ll be eligible for home health care services.3

Home health services covered by Original Medicare

If you’re eligible for Medicare-covered home health care, services covered may include:4

  • Part-time or intermittent skilled nursing care
  • Physical therapy
  • Occupational therapy
  • Speech-language pathology services
  • Medical social services
  • Part-time or intermittent home health aide services (personal hands-on care)
  • Injectable osteoporosis drugs for women

Note: Medicare will not pay for 24-hour-a-day care or meals delivered to your home. It also won’t cover homemaker, custodial or personal care if that’s the only care you need.5

What you pay for home health services

All eligible Medicare recipients pay the following for home health services:6


Before home health care begins, your home health agency should explain your bill. This includes what Medicare will cover, what Medicare won’t cover and how much you’ll owe (if anything). The details of what isn’t covered by Medicare must be given to you in an Advance Beneficiary Notice (ABN) before you receive any uncovered items or services.7

Learn more about Medicare coverage

For information on prescriptions, home health services and more, check out what Medicare does and doesn’t cover.

Sources

  1. “What’s home health care,” Medicare.gov, last accessed March 3, 2021, https://www.medicare.gov/what-medicare-covers/whats-home-health-care, opens new window.
  2. “Medicare & Home Health Care,” Medicare.gov, last accessed March 3, 2021, https://www.medicare.gov/Pubs/pdf/10969-medicare-and-home-health-care.pdf, PDF opens new window.
  3. “Medicare & Home Health Care.”
  4. “Home health services,” Medicare.gov, last accessed March 3, 2021, https://www.medicare.gov/coverage/home-health-services#2781, opens new window.
  5. “Home health services.”
  6. “Home health services.”
  7. “Home health services.”

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