Medicare and Continuing Care
Home Health Care
A serious illness or injury can create a need for ongoing care. With the right kind of support, some people can continue to lead independent, productive lives at home. Others may need full-time care outside the home. And for those who cannot recover, end-of-life care may be the answer. Medicare can cover costs for some continuing care needs.
(Watch the video for important information about Medicare and home health care. 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.)
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.
Who Is Eligible?
All people with Part A and/or Part B who meet all of these conditions are covered:
- You must be under the care of a doctor, and you must be getting services under a plan of care established and reviewed regularly by a doctor.
- You must need, and a doctor must certify that you need, one or more of these:
- Intermittent skilled nursing care (other than just drawing blood)
- Physical therapy, speech-language pathology, or continued occupational therapy services. These services are covered only when the services are specific, safe and an effective treatment for your condition. The amount, frequency and time period of the services needs to be reasonable, and they need to be complex or only qualified therapists can do them safely and effectively. To be eligible, either: 1) your condition must be expected to improve in a reasonable and generally-predictable period of time, or 2) you need a skilled therapist to safely and effectively make a maintenance program for your condition, or 3) you need a skilled therapist to safely and effectively do maintenance therapy for your condition.
You're not eligible for the home health benefit if you need more than part-time or "intermittent" skilled nursing care.
You may leave home for medical treatment or short, infrequent absences for non-medical reasons, like attending religious services. You can still get home health care if you attend adult day care.
Note: Home health services may also include medical social services, part-time or intermittent home health aide services, medical supplies for use at home, durable medical equipment, or injectable osteoporosis drugs.
Your costs in Original Medicare
- $0 for home health care services.
- 20% of the Medicare-approved amount for durable medical equipment.
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.
To find out if a patient is eligible for Medicare's home health care services, visit https://www.medicare.gov/ and click on “What Medicare Cover” tab and select “What Medicare Part A Cover” click on “Home Health Care” from the dropdown list 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 http://www.medicare.gov. TTY users should call 1-877-486-2048.
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, visit https://www.medicare.gov/homehealthcompare, or ask the doctor or hospital discharge planner, use a senior community referral service or agency.
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 https://www.medicare.gov/homehealthcompare/
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.