Medicare and Continuing Care

Frequently Asked Questions

11. Who is eligible for the Medicare home health benefit?

If a patient has Medicare, he or she can use the home health benefit if all of the following conditions are met.

  1. 1.
    The doctor must decide that the patient needs medical care at home and makes a plan for this care.
  2. 2.
    The patient must need one or more of the following services.
    • intermittent skilled nursing care
    • physical therapy
    • speech-language pathology services
    • continued occupational therapy
  3. 3.
    The home health agency selected must be approved by the Medicare Program (Medicare-certified).
  4. 4.
    The patient must be homebound or normally unable to leave home unassisted. To be homebound means that leaving home takes considerable effort. A person may leave home for medical treatment or short, infrequent absences for non-medical reasons, such as a trip to attend religious services. A person can still get home health care if he or she attends adult day care.

To find out if a patient is eligible for Medicare's home health care services, 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 http://www.medicare.gov. TTY users should call 1-877-486-2048.

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