If you have Medicare, home health care services are covered if you meet all the following conditions:
- Your 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 to continue occupational therapy.
- The home health agency caring for you must be approved by the Medicare program (Medicare-certified).
- You must be homebound, or normally unable to leave home without help. To be homebound means that leaving home takes considerable and taxing effort. You can be homebound and still leave home for medical treatment or short, infrequent absences for non-medical reasons, such as trips to a barber or church. A need for adult day care doesn’t keep you from getting home health care.
If you meet all four of the conditions above, Medicare will cover the following types of home health care:
- Skilled nursing care on a part-time or intermittent basis. Skilled nursing care includes services and care that can only be performed safely and correctly by a licensed nurse (either a registered nurse or a licensed practical nurse).
- Home health aide services on a part-time or intermittent basis. A home health aide doesn’t have a nursing license, but supports the nurse by providing services such as help with bathing, using the bathroom, dressing, or other personal care. These types of services don’t need the skills of a licensed nurse. Medicare doesn’t cover home health aide services unless you are also getting skilled care such as nursing care or other therapy. The home health aide services must be part of the home care for your illness or injury.
- Physical therapy, speech-language therapy, and occupational therapy for as long as your doctor says you need it.
- Physical therapy includes exercise to regain movement and strength in a body area, and training on how to use special equipment or do daily activities, like how to get in and out of a wheelchair or bathtub.
- Speech-language therapy (pathology services) includes exercise to regain and strengthen speech skills.
- Occupational therapy includes exercise to help you do usual daily activities by yourself. You might learn new ways to eat, put on clothes, comb your hair, and perform other usual daily activities. You may continue to receive occupational therapy if ordered by your doctor even if you no longer need other skilled care.
- 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, such as a wheelchair or walker.
- Food and Drug Administration (FDA)-approved injectable osteoporosis drugs in certain circumstances.
Currently, Medicare does not cover (does not pay) for any of the following:
- 24-hour-a-day care at home;
- Meals delivered to your home;
- Homemaker services like shopping, cleaning, and laundry; and
- Personal care given by home health aides like bathing, dressing, and using the bathroom when this is the only care you need.
Most of the time, your doctor, a social worker, or a hospital discharge planner will help arrange for Medicare-covered home health care. However, you have a say in which home health care agency you use.