Sometimes, a person may need intermittent or temporary home healthcare, such as after a hospital stay when they still require a certain amount of care.
Medicare can cover various home healthcare services.
| Type of care | When it is covered |
|---|---|
| Skilled nursing care | • A person’s care needs require skilled nursing. • The services a person needs are reasonable and necessary for treating the injury or illness. • A person receives services intermittently or part-time, meaning fewer than 8 hours per day and 28 hours or fewer per week. |
| Physical therapy Occupational therapy Speech-language pathology | • The services are a safe, effective, and specific treatment for a condition. • They are complex enough that a person can only get them effectively and safely from a qualified therapist. • The condition requires therapy to improve or restore functions affected by illness or injury, or a skilled therapist or therapist assistant is necessary to effectively and safely perform therapy to prevent the condition from worsening or maintain the current condition. • Medicare deems the frequency, amount, and duration reasonable. |
| Home health aide | • The illness or injury requires health aide services, such as personal care. • The care requires intermittent or part-time home health aide services. • A person also receives skilled care, such as skilled nursing or physical therapy. |
| Medical social services | • A doctor orders social services, such as counseling, or helps find community resources to help with social and emotional concerns that may interfere with recovery. • A person also receives skilled care. |
| Medical supplies | A doctor orders supplies, like wound dressings, as part of care. |
Durable medical equipment, like hospital beds, walkers, or wheelchairs, is not billed as part of home healthcare services. It is billed and covered under its own category within Medicare Part B.
Medicare Part A or Part B can cover home healthcare services if a person needs intermittent or part-time care and cannot leave home without assistance. When a person cannot leave home without assistance, Medicare refers to this as “homebound.”
It defines “homebound” as:
- difficulty leaving home without needing help due to illness or injury
- possession of a doctor’s recommendation to avoid leaving home because of illness or injury
- challenges leaving home because it requires a major effort
To qualify for home healthcare services, a doctor or another healthcare professional must assess a person face-to-face and certify they require this type of care.
What is not covered
Medicare does not cover:
- meal delivery services
- 24-hour-a-day care at home
- homemaker services, such as shopping and cleaning, that are unrelated to a person’s plan
- custodial or personal care that helps with daily activities, such as bathing or dressing, when this is the only care a person receives
Typically, a person does not need to pay anything for home health services. The home health agency should inform the person how much Medicare can pay and whether the agency provides services or items Medicare does not cover. The agency should also tell a person how much these services may cost.
Once a person meets the Part B deductible of $257, they are responsible for 20% of the Medicare-approved costs for medical equipment.