Does Medicare Cover Home Health Care

Home health care is one of the most valuable Medicare benefits that many people do not fully understand until they need it. Medicare does cover certain home health services -- and it covers them well, with no deductible or coinsurance. But the eligibility requirements are specific, and there is an important distinction between the skilled care Medicare covers and the personal care services many families want.

What Medicare Covers Under Home Health

Medicare covers home health care when you need skilled care and you are homebound. Specifically, the covered services include:

• Skilled nursing care (wound care, injections, monitoring complex conditions)
• Physical therapy
• Speech-language pathology services
• Occupational therapy
• Medical social services (counseling, help arranging community resources)
• Part-time or intermittent home health aide services (help with personal care like bathing and dressing, but only when you also need skilled care)
• Medical equipment and supplies used at home

The Eligibility Requirements

You must be homebound. Medicare defines homebound as meaning that leaving your home requires considerable effort, or that you have a condition that makes leaving medically inadvisable. You do not have to be bedridden. Leaving for medical appointments, short trips to religious services, or occasional non-medical outings does not disqualify you. But you cannot simply be choosing to stay home -- there needs to be a medical basis.

A doctor must certify the need. Your doctor or an allowed practitioner must certify that you need skilled care and must review and reauthorize the home health plan periodically.

The care must be skilled. The care you need must require the expertise of a licensed nurse, physical therapist, speech therapist, or occupational therapist. This is the most misunderstood requirement.

The agency must be Medicare-certified. Home health care must be provided by an agency that is certified by Medicare.

What Medicare Does NOT Cover

This is where many families get disappointed. Medicare does not cover custodial care -- the day-to-day assistance with activities like cooking, cleaning, grocery shopping, transportation, and general companionship. It does not cover 24-hour-a-day nursing care at home. It does not cover personal care services provided by a home health aide unless skilled care is also being provided concurrently.

These custodial services, which many families most want and need as aging parents require more support, are generally not covered by Medicare. Medicaid covers some long-term home and community-based services for people who qualify financially, but Medicare does not.

How Long Does Medicare Cover Home Health

There is no set limit on the number of home health visits Medicare covers, as long as you continue to meet the eligibility requirements. Coverage continues as long as you are homebound, have a documented medical need for skilled care, and your doctor certifies the ongoing necessity. Medicare does conduct periodic reviews of home health claims.

The key is that coverage is meant to be short-term and goal-oriented -- helping you recover from an illness or injury, manage a medical condition, or regain function through therapy. It is not designed as a permanent long-term care solution.

How to Access Medicare Home Health Benefits

Your doctor must order home health services and write a care plan. Ask your doctor or hospital discharge planner whether you qualify when you are being discharged from a hospital or when your condition changes. They can refer you to a Medicare-certified home health agency.

You can also search for Medicare-certified home health agencies at medicare.gov using the Care Compare tool, which includes quality ratings and patient reviews.