Home health services mean you receive health care in your own home instead of in the hospital or Skilled Nursing Facility (SNF) when required. Medicare may provide coverage for home health services if you need a kind of therapy, hospice, skilled nursing care, or other services in your home. However, if you need custodial care, Medicare probably won’t cover it.
Who Can Receive Home Health Services Covered by Medicare?
To be eligible for home health services, you must have coverage through Original Medicare and meet the following conditions:
- You must be under the care of a doctor, and he or she must prescribe a treatment plan that requires medically necessary services for the maintenance or treatment of your health condition.
- You must be certified homebound by your doctor. “Homebound” doesn’t mean you must be bedridden, just that it’s difficult for you to leave home due to your reliance on a mobility aid, like a walker or wheelchair. You won’t lose eligibility for home health services if you go out occasionally for medical treatments or non-medical activities such as a short walk, religious services, family events, or weddings.
- You must be certified by your doctor to need home health services. For Medicare to cover you, your doctor must create a care plan that includes the medically necessary services. For speech pathology, physical and occupational therapy, the services required must be considered specific, effective, and safe treatments for your health conditions.
- The home health care services you require must be offered by a Medicare-approved home health care agency.
Which Home Health Care Is Covered by Medicare?
Medicare provides coverage for a wide range of home health services. Medicare provides coverage for about 8 hours a day and a total of 28 hours per week. However, for some beneficiaries, Medicare covers about 35 hours per week of home health service. Medicare will assess your need for 35 hours per week of home health services on a case by case basis. The services covered by Medicare include:
- Skilled nursing care
- Home health aides
- Medical social services
- Injectable osteoporosis medicines for women
- Durable medical equipment supplies for home use
- Rehabilitation therapy (Speech pathology, physical and occupational therapy)
What’s Not Covered by Medicare?
The following services are generally not covered by Medicare:
- Meal delivery
- 24-hour home care
- Domestic services such as shopping, cleaning, and laundry
- Personal or long-term care such as bathing, dressing, or toileting
How Much Do Home Health Services Cost?
With Original Medicare coverage, you’ll pay nothing for home health care services as long as it’s ordered by a doctor and offered by a Medicare-certified home health agency. If you receive any additional services outside of the approved home health care plan, you must pay out of pocket.
Before the services start, the agency that provides the service should present an itemized plan or receipt of care, classifying what qualifies for Medicare coverage.
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