Leaving your home to receive health care can be difficult or impossible for some. This blog post covers how Medicare covers home health care.

First, what is home health care exactly?

Home health care includes health and social services that you receive in your home to treat an illness or injury. Medicare covers the following home health care:

• Skilled nursing services.
• Skilled therapy services, such as physical therapy, speech therapy, or occupational therapy.
• A home health aide, who provides personal care services like bathing and dressing, but only if you also need skilled care, like nursing or therapy.
• Medical social services to help with social and emotional concerns related to your illness.
• Medical supplies, like wound dressings and catheters provided by a Medicare-certified home health agency.
• Durable medical equipment, such as a wheelchair or walker.

Medicare covers your home health care if you meet certain criteria.

• First, you must be homebound.
• Second, you must also need either or both skilled nursing services and skilled therapy care on an intermittent basis.
• Next, you must have a face-to-face meeting with a doctor within the 90 days before you start home health care, or the 30 days after the first day you receive care. This can be an office visit, hospital visit, or in certain circumstances, a telemedicine visit. Your doctor must sign a home health certification confirming that you are homebound, that you need intermittent care, that your doctor has approved a plan of care for you, and that the face-to-face requirement was met. To continue receiving home health care, your doctor should review and certify your plan or care every 60 days. A face-to-face meeting is not required for recertification.
• Finally, for Medicare to cover your home health care, you must receive it from a Medicare-certified home health agency (HHA). Your doctor or discharge planner may help you coordinate with an HHA. You can also contact Medicare at 1-800-MEDICARE or www.medicare.gov/care-compare to find a Medicare-certified HHA by you.

It is important to note that Medicare should cover your care even if your condition is chronic, not temporary. Some doctors or home health agencies may worry that Medicare will not cover your home health care if your condition is not improving. However, Medicare should cover your home health care as long as it is medically necessary to maintain your condition or to prevent or slow deterioration. This applies to both people with Original Medicare and Medicare Advantage Plans.

Home health can be covered by either Medicare Part A or Part B.

Let’s talk a little more about what it means to be considered homebound.

To be eligible for Medicare coverage of home health services, you must be homebound. Medicare considers you homebound if you need the help of another person or medical equipment such as crutches, a walker, or a wheelchair to leave your home. You are also considered homebound if your doctor believes that your health or illness could get worse if you leave your home. It must be difficult for you to leave your home and doing so requires a lot of effort. Your doctor should decide if you are homebound based on their evaluation of your condition. Even if you are homebound, you can still leave your home for medical treatment, religious services, or to attend a licensed or accredited adult day care center. Leaving home for short periods of time or special non-medical events, such as a family reunion, funeral, or graduation, should also not affect your homebound status. You may also take occasional trips to the barber or salon.

For individualized information and assistance about Medicare’s coverage of home health, contact your local State Health Insurance Assistance Program (SHIP). Use our online SHIP Locator or call 877-839-2675 (and say “Medicare” when prompted) to find your local SHIP

Finally, be on the lookout for potential Medicare home health fraud or abuse.

To prevent and detect home health fraud and abuse, you can protect your Medicare number and read your Medicare statements when you receive them. If you have Original Medicare, you should receive a Medicare Summary Notice, or MSN. If you have a Medicare Advantage Plan, you should receive an Explanation of Benefits, or EOB. Read these thoroughly to check for any suspicious charges.

Here are some examples of potential home health fraud to watch for:

• You see charges on your MSN or EOB for services that you did not receive, that were not prescribed by your doctor, or when you do not meet Medicare’s homebound criteria.
• You are enrolled in home health services by a doctor you do not know.
• A home health agency offers you “free” groceries or “free” transportation in exchange for personal information or to switch to a different home health agency.
• You are charged a copayment for home health services.
• You are asked to sign forms saying that you received home health services that you did not receive.

If you think you may have experienced potential Medicare fraud, errors, or abuse you should contact your local Senior Medicare Patrol by calling 877-808-2468 or visiting www.smpresource.org.

Still have questions?   

Your SHIP is here for you! You can contact your SHIP for any other Medicare-related questions or concerns you have. SHIP counselors are government funded to provide trusted, unbiased Medicare counseling at no cost to you. (Depending on your state, your SHIP may go by another name.) Use our online SHIP Locator or call 877-839-2675 (and say “Medicare” when prompted) to find your local SHIP.

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