Home health care includes a wide range of health and social services delivered in your home to treat illness or injury. If you qualify for the home health benefit, Medicare covers:
- Skilled nursing services provided up to seven days per week for generally no more than eight hours per day and 28 hours per week.
- Skilled therapy services, such as physical, speech, and occupation therapy.
- Home health aide, so long as you require skilled care as well.
- Medical social services to help with social or emotional concerns related to your illness.
- Certain medical supplies, such as wound dressings and catheters.
- Certain durable medical equipment (DME), such as a wheelchair or walker.
Note: Medicare should pay for these services regardless of whether your condition is temporary or chronic and regardless of whether your condition is improving or not.
Medicare will cover your home health care if you meet all of the following conditions:
- You are homebound, meaning it is extremely difficult for you to leave your home and you need help doing so.
- You need skilled nursing services on an intermittent basis and/or skilled therapy care. Skilled therapy refers to physical, speech, and occupational therapy. You cannot qualify for Medicare home health coverage if you only need occupational therapy. However, if you need other skilled services as well, you could also receive occupational therapy.
- You have a face-to-face meeting with your doctor within the 90 days before you start home health care, or the 30 days after the first day you receive care. This meeting can be facilitated by technology such as video conferencing.
- 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, if needed, re-certify your home health plan every 60 days.
- You receive care from a Medicare-certified home health agency (HHA). If you need help finding a Medicare-approved HHA, call an ADRC Benefit Specialist at (920) 448-4300. If you have a Medicare Advantage Plan, contact your plan for a list of in-network HHAs.
