Your home health care benefits with Medicare
April 1, 2021 | View PDF
What is home health care? What services are included in home health care? Who is eligible for these services? These are some common questions that people have about their Medicare benefits.
Home health care includes a wide range of health and social services delivered in your home to treat illness or injury. Medicare covers skilled nursing services, such as injections and catheter changes. It covers home health aides, such as to help with bathing and dressing, and medical social services, such as counseling. It also covers skilled therapy services, such as physical, speech and occupational therapy. Finally, Medicare’s home health benefit covers certain medical supplies, such as wound dressings and catheters as well as certain durable medical equipment, like a wheelchair or walker.
You must first be considered homebound to be eligible for home health care benefits. This means it is extremely difficult for you to leave your home and require the assistance of medical equipment or other people to do so. Second, you must need skilled nursing or therapy services. Third, you must have a face-to-face meeting with a doctor within the 90 days before or the 30 days after you begin receiving care at home. This meeting can be conducted via telehealth. Fourth, your doctor must sign for and approve your plan of care. Last, you must receive care from a Medicare-certified home health agency.
The definition of homebound has been broadened during the coronavirus public health emergency to include being certified by your physician that you cannot leave your home because you are at risk of medical complications if you go outside, or if you have a suspected or confirmed case of COVID-19.
Medicare has also expanded telehealth services during the coronavirus public health emergency. A telehealth service is a full visit with a provider using technology that allows for both audio and video communication. Depending on the situation, you might access telehealth from your home or at a medical facility. Original Medicare usually only covers telehealth in limited situations, like if you require telehealth services due to an acute stroke or behavioral health conditions, or if you live in a rural area.
There are limits to the home health care benefit. Home health care is limited to no more than eight hours per day and usually 28 hours per week. In certain cases, you could receive up to 35 hours per week if needed. You can continue to receive home health care for as long as you qualify, but it must be approved by your doctor every 60 days. Contact the Medicare Information Office for individualized counseling and assistance about your home health coverage.
Colton T. Percy is a Certified Medicare Counselor and the Volunteer Coordinator for the Alaska Medicare Information Office. If you have questions about Medicare or are interested in volunteering and helping your fellow Alaskans navigate Medicare, please call 1-800-478-6065 or 907-269-3680.