Home Health Services Covered by Medicare

Home health services covered by Medicare have limitations and rules. I just learned something new from the Medicare Rights Center.

Home health services covered by Medicare:

Original Medicare will cover certain home health care services through the home health benefit under certain circumstances. Home health care services must be ordered by a doctor and coordinated through a home health care agency.

Medicare covers the following types of care:
•Skilled nursing services. Medicare pays in full for part-time skilled nursing care, which is care that can only be performed safely by a licensed nurse. Part-time means the care is provided up to seven days a week for no more than eight hours per day and 28 hours per week.
•Skilled therapy services. This includes physical, speech, and occupational therapy provided by a licensed therapist. Note that occupational therapy is only covered if your father also needs physical or speech therapy. Your father will not qualify for the home health benefit if he only has a need for occupational therapy.
•Home health care services provided by a home health aide if your father also needs skilled care. Home health aides provide personal care such as help using the bathroom. If your father only needs personal care, he will not qualify for the home health care benefit.

Under the home health care benefit, Medicare also covers medical social services such as counseling, medical supplies such as catheters, and durable medical equipment such as a wheelchair or a walker.

It is important to note that although the home health benefit covers the services of a home health aide when skilled care is also needed, it does not cover 24-hour care. The home health benefit also does not pay for meals delivered to your home or homemaker services such as grocery shopping.

Medicare covers home health care if:
•Your father’s doctor has certified that he is homebound, meaning it is very difficult for him to leave the home, and he needs help doing so.
•Your father needs skilled nursing services on a part-time basis and/or skilled therapy.
•Your father has a face-to-face meeting with a doctor within the 90 days before beginning to receive home health care, or within 30 days after the first day he receives care. His doctor must sign a certification of home health care and re-certify it every 60 days.
•Your father receives home health care from a Medicare-certified home health agency.

 

This information came from the Medicare Rights Center web page.

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2 Responses to "Home Health Services Covered by Medicare"

  1. Denise says:

    I got an email from a reader of this blog who works for a home health agency. She says the info about how much Medicare covers does not match what actually gets provided to patients. She said that many families read the Medicare guidelines and are disappointed that home health agencies will not provide services to the extent they are supposed to be covered by Medicare. She wrote:

    Even though the CMS [Medicare] info states what it does for Nursing, there are very few home health agencies, if any, that allow an RN to visit a patient daily never mind all day for 7 days a week. I am not sure what it really means but its not put in practice.

    Some agencies limit their home health to three weeks with about 6 PT visits.

  2. My mother has had some very severe health problems lately that have limited her mobility and she needs someone to come look after her on a regular basis. You mentioned that home health care services are provided by a home health aide if your parent needs skilled care. Do most home health care services have aides or nurses that come to your house every day? It seems that this could be a valuable option for her.

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