The process for starting the Medicare home health benefit changes depending on whether you are currently in a hospital or if you are already at home. Remember, in both cases you must meet the eligibility requirements and qualify for coverage under either Part A or Part B. If you are
Home health care
Home health hours
Medicare’s home health benefit covers skilled nursing care and home health aide services provided up to seven days per week for no more than eight hours per day and 28 hours per week. If you need additional care, Medicare provides up to 35 hours per week on a case-by-case basis.
Plan of care
Before you receive Medicare-covered home health care, your home health agency (HHA) should assess your condition to create a plan of care. Generally, your plan of care will list: The types of health services and items you need How often you will receive services The predicted outcomes of treatment Your
Home health care for chronic conditions
If you meet Medicare’s home health eligibility requirements, Medicare should cover your care regardless of whether your condition is temporary or chronic. Medicare covers skilled nursing and therapy services as long as they: Help you maintain your ability to function Help you regain function or improve Or, prevent or slow
Medicare Advantage and home health
All Medicare Advantage Plans must provide at least the same level of home health care coverage as Original Medicare, but they may impose different rules, restrictions, and costs. Depending on your plan, you may need to: Get care from a home health agency (HHA) that contracts with your plan Request
Services excluded from home health coverage
Medicare’s home health benefit does not cover all home care services. Services excluded from Medicare coverage include: 24-hour per day care at home Prescription drugs If you need prescription drug coverage, enroll in a Part D plan or a Medicare Advantage Plan that provides drug coverage. Meals delivered to your
Home health covered services
If you qualify for the home health benefit, Medicare covers the following: Skilled nursing services: Services performed by or under the supervision of a licensed or certified nurse to treat your injury or illness. Services you may receive include injections (and teaching you to self-inject), tube feedings, catheter changes, observation
Eligibility for home health (Part A or Part B)
You can receive home health care coverage under either Medicare Part A or Part B. Under Part B, you are eligible for home health care if you are homebound and need skilled care. There is no prior hospital stay requirement for Part B coverage of home health care. There is
The homebound requirement
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, or your doctor believes that your health or illness could get worse if you leave your home And, it is difficult for you
Home health basics
Home health care includes a wide range of health and social services delivered in your home to treat illness or injury. Services covered by Medicare’s home health benefit include intermittent skilled nursing care, therapy, and care provided by a home health aide. Depending on the circumstances, home health care will
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