Home health services (original) (raw)
Home health is a wide range of health care services that you can get in your home for an illness or injury. Home health care is usually less expensive, more convenient, and just as effective as care you get in a hospital or skilled nursing facility (SNF).
Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance) cover eligible home health services as long as you need part-time or intermittent skilled services and you’re “homebound,” which means:
- You have trouble leaving your home without help (like using a cane, wheelchair, walker, or crutches; special transportation; or help from another person) because of an illness or injury.
- Leaving your home isn’t recommended because of your condition.
- You’re normally unable to leave your home because it’s a major effort.
Covered home health services include:
- Medically necessary part-time or intermittent skilled nursing care, like:
- Wound care for pressure sores or a surgical wound
- Patient and caregiver education
- Intravenous or nutrition therapy
- Injections
- Monitoring serious illness and unstable health status
- Physical therapy
- Occupational therapy
- Speech-language pathology services
- Medical social services
- Part-time or intermittent home health aide care (only if you’re also getting skilled nursing care, physical therapy, speech-language pathology services, or occupational therapy at the same time), like:
- Help with walking
- Bathing or grooming
- Changing bed linens
- Feeding
- Injectable osteoporosis drugs for women
- Durable medical equipment
- Medical supplies for use at home
- Disposable negative pressure wound therapy devices
A doctor or other health care provider (like a nurse practitioner) must assess you face-to-face before certifying that you need home health services. A doctor or other health care provider must order your care, and a Medicare-certified home health agency must provide it.
If your provider decides you need home health care, they should give you a list of agencies that serve your area. They must tell you if their organization has a financial interest in any agency listed.
In most cases, "part-time or intermittent" means you may be able to get skilled nursing care and home health aide services up to 8 hours a day (combined), for a maximum of 28 hours per week. You may be able to get more frequent care for a short time (less than 8 hours each day and no more than 35 hours each week) if your provider determines it's necessary.
Medicare doesn't pay for:
- 24-hour-a-day care at your home
- Home meal delivery
- Homemaker services (like shopping and cleaning) unrelated to your care plan
- Custodial or personal care that helps you with daily living activities (like bathing, dressing, or using the bathroom), when this is the only care you need
You won't qualify for the home health benefit if you need more than part-time or "intermittent" skilled care. You may leave home for medical treatment or short, infrequent absences for non-medical reasons, like attending religious services. You can still get home health care if you attend adult day care.
Your costs in Original Medicare
- $0 for covered home health care services.
- After you meet the Part B deductible, 20% of the Medicare-approved amount for Medicare-covered medical equipment.
Before you start getting your home health care, the home health agency should tell you how much Medicare will pay. The agency should also tell you (both verbally and in writing) if Medicare won't pay for any items or services they give you, and how much you'll have to pay for them. The home health agency should give you a notice called the "Advance Beneficiary Notice" (ABN) before giving you services and supplies that Medicare doesn't cover.
If you get your Medicare benefits through a Medicare Advantage Plan (Part C) or another Medicare health plan, check with your plan for more information about your home health benefits. If you have a Medicare Supplement Insurance (Medigap) policy or other health insurance coverage, tell your doctor or other provider so your bills get paid correctly.
If you get services from a home health agency in Florida, Illinois, Ohio, North Carolina, or Texas, you may be affected by a Medicare demonstration program. Under this demonstration, your home health agency may submit a request for pre-claim review of coverage for home health services to Medicare. This helps you and the home health agency know earlier in the process if Medicare is likely to cover the services. Medicare will review the information and cover the services if the services are medically necessary and meet Medicare requirements.
Your Medicare home health services benefits aren't changing and your access to home health services shouldn’t be delayed by the pre-claim review process. For more information, call us at 1-800-MEDICARE. TTY users can call 1-877-486-2048.
Things to know
- Once your doctor or other provider refers you for home health services, the home health agency will schedule an appointment to talk to you about your needs and ask you some questions about your health.
- The home health agency staff will also talk to your doctor or other provider about your care plan and keep them updated on your progress. What's a home health care plan?
- It’s important that home health staff visit you as often as the doctor or other provider ordered. What health care services will my home health staff provide?