Medicare and Continuing Care
Frequently Asked Questions
11. Who is eligible for the Medicare home health benefit?
All people with Part A and/or Part B who meet all of the following conditions are covered.
- The doctor must decide that the patient needs medical care at home, and makes a plan for this care.
The patient must need one or more of the following services.
- intermittent skilled nursing care
- physical therapy
- speech-language pathology
- continued occupational therapy
- These services are covered only when the services to be provided are specific, safe and an effective treatment for a patient's condition. The amount, frequency and time period of the services needs to be reasonable, and they need to be complex or ones that only qualified therapists can do safely and effectively.
- The home health agency selected must be approved by the Medicare Program (Medicare-certified).
- A patient must be homebound, and a doctor must certify that the patient is homebound. To be homebound means that leaving home takes considerable effort. Patients may leave home for medical treatment or short, infrequent absences for non-medical reasons, such as a trip to attend religious services. A patient can still get home health care if he or she attends adult day care.
- A patient is not eligible for the home health benefit if more than part-time or "intermittent" skilled nursing care is needed.
Along with the above eligibility requirements, at least one of the following conditions must be met.
- A patient's condition must be expected to improve in a reasonable and generally-predictable period of time, or
- The patient needs a skilled therapist to safely and effectively make a maintenance program for the condition, or
- A patient needs a skilled therapist to safely and effectively do maintenance therapy for the condition.
To find out more about Medicare's home health care services, visit "Home Health Services" at www.medicare.gov. Or call the Regional Home Health Intermediary (RHHI). A RHHI is a private company that contracts with Medicare to pay bills and check on the quality of home health care. To contact a RHHI, call 1-800-Medicare (1-800-633-4227) or visit www.medicare.gov. TTY users should call 1-877-486-2048.
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