Medicare guidelines for home health services

How often is home health care covered by Medicare?

The simple answer is as needed and ordered by your doctor. Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance) covers eligible home health services like intermittent skilled nursing care, physical therapy, speech-language pathology services, continued occupational services, and more.

Medicare does not cover the following:

  • 24-hour-a-day care at home
  • Meals delivered to your home
  • Homemaker services
  • Personal care when it is not accompanied with a skill service

To be eligible for home health care by Medicare you must meet the following conditions:

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. The doctor must see you face-to-face.

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 must be homebound, and a doctor must certify that you’re homebound.

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.

Your costs in Original Medicare:

$0 for home health care services.

20% of the Medicare-approved amount for durable medical equipment.