Home health care provides medical treatment for an illness, injury or chronic condition with the goal of helping you recover, regain your independence and become as self-sufficient as possible, and is covered by Medicare and many private insurers.
Medicare Eligibility
For patients covered by Medicare, there are several requirements that must be met in order for them to qualify for home health care:
- You doctor must decide that you need medical care at home and make a plan for your care at home.
- You must need intermittent skilled nursing care, physical therapy, speech-language therapy or continuation of occupational therapy.
- You must be homebound, restricted in your ability to leave home, and your homebound status must be certified by a physician. You are considered to be homebound if you are confined to your home due to illness or injury. It is not mandatory that you are bedridden, but leaving your resident must require a considerable taxing effort and the need for supportive devices such as a cane, wheelchair, or the help of another person. Homebound status is not affected if you leave the home to receive medical treatment(s).
- A person may leave home for medical treatment or short, infrequent absences for non-medical reasons, such as attending religious services. You can still get home health care if you attend adult day care, but you would get the home care services in your home.
- If you meet the conditions above, Medicare pays for your covered home health services for as long as you’re eligible and your doctor certifies you need them. If you need more than part-time or “intermittent” skilled nursing care, you aren’t eligible for the home health benefit.
What is Covered Under Medicare
- Skilled Nursing
- Home Health Aide
- Physical, Occupational and Speech Therapy
- Medical social services to help you with social and emotional concerns related to your illness. This might include counseling or help in finding resources in your community.
- Certain medical supplies, like wound dressings (but not prescription drugs or biologicals).
- Durable medical equipment like a wheelchair or walker
- Food and Drug Administration (FDA)-approved injectable such as osteoporosis medications, if approved.
Medicare Will Not Cover
- 24-hour-a-day care at home
- Meals delivered to your home
- Homemaker services like shopping, cleaning and laundry
- Personal care given by home health aides like bathing, dressing and using the bathroom without skilled nursing or therapy services
Medicaid and Insurance Eligibility
Many state Medicaid programs and commercial insurance plans offer full or partial home health care coverage. The eligibility requirements vary by state and by insurance company, so it’s best to contact your state Medicaid program or private insurer directly to learn about their specific requirements. Additionally, some Medicaid programs and private insurers may provide coverage for some services that Medicare does not.
