Medicare and Continuing Care
Home Health Care
What Is Home Health Care?
Home health care is short-term skilled care at home after hospitalization or for the treatment of an illness or injury. Home health agencies provide home care services, including skilled nursing care, physical therapy, occupational therapy, speech therapy, medical social work, and care by home health aides.
Home health services may also include durable medical equipment, such as wheelchairs, hospital beds, oxygen, and walkers, and medical supplies for use at home.
(Watch the video to learn more about home health care and Medicare. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.)
Who Is Eligible?
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 if a patient is eligible for 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.
Finding Out About Costs
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 if any items or services they give you aren't covered by Medicare, and how much you'll have to pay for them. This should be explained by both talking with you and in writing. The home health agency should give you a notice called the "Home Health Advance Beneficiary Notice" (HHABN) before giving you services and supplies that Medicare doesn't cover.
If you have Original Medicare, your costs will be
- $0 for home health care services
- 20% of the Medicare-approved amount for durable medical equipment.
Choosing a Home Health Care Agency
If the doctor decides the patient needs home health care, you can choose an agency from the participating Medicare-certified home health agencies that serve the area. To find an agency, ask the doctor or hospital discharge planner, use a senior community referral service or agency, or look in the telephone directory in the Yellow Pages under "home care" or "home health care."
Home health agencies are certified to make sure they meet certain Federal health and safety requirements. The choice of a home health agency should be honored by the patient's doctor, hospital discharge planner, or other referring agency.
Questions to Consider
Here are questions to ask when considering a home health agency.
- Is the agency Medicare-approved?
- How long has the agency served the community?
- Does this agency provide the services my relative or friend needs?
- How are emergencies handled?
- Is the staff on duty around the clock?
- How much do services and supplies cost?
- Will agency staff be in regular contact with the doctor?
You can use Medicare's "Home Health Compare" tool to compare home health agencies in your area. Visit "Find a Home Health Agency" at www.medicare.gov.
Community Based Services
There are times when a person's needs extend beyond the intermittent skilled care provided through Medicare. Community-based services across the country support independent living and are designed to promote the health, well being, and independence of older adults. These services can also supplement the supportive activities of family caregivers.
Often, community-based senior citizens' services offer companionship visits, help around the house, meal programs, caregiver respite, adult day care services, transportation, and more. These support services may be funded by state and county programs or offered by church or volunteer groups.