Medicare coverage for home health care

Receiving home health care can be available for some Medicare recipients. To be eligible for Medicare coverage of home health services, you must be homebound. In other words, it must be difficult for you to leave your home and doing so requires a lot of effort. Medicare considers you homebound if you need help to leave your home. The help you need can be from another person or from medical equipment such as crutches, a walker or a wheelchair. You are also considered homebound if your doctor believes that your health or illness could get worse if you leave your home. Your doctor should decide if you are homebound based on their evaluation of your condition. Even if you are homebound, you can still leave your home for medical treatment, religious services, or to attend a licensed or accredited adult day care center. Leaving home for short periods of time or special non-medical events, such as a family reunion, funeral or graduation, should also not affect your homebound status. You may also take occasional trips to the barber or salon.

What is home health care?

Home health care includes health and social services that you receive in your home to treat an illness or injury. Medicare covers the following home health care:

Skilled nursing services;

Skilled therapy services, such as physical therapy, speech therapy or occupational therapy;

A home health aide, who provides personal care services like bathing and dressing, but only if you also need skilled care, like nursing or therapy;

Medical social services to help with social and emotional concerns related to your illness;

Medical supplies, like wound dressings and catheters provided by a Medicare-certified home health agency; and

Durable medical equipment, such as a wheelchair or walker.

When Medicare will cover home health care

Medicare covers your home health care if you meet certain criteria. In addition to being homebound, you must also have a medical requirement for skilled nursing services and/or skilled therapy care on an intermittent basis.

Next, you must have a face-to-face meeting with a doctor within the 90 days before you start home health care, or the 30 days after the first day you receive care. This can be an office visit, hospital visit, or in certain circumstances, a telemedicine visit. Your doctor must sign a home health certification confirming that you are homebound, that you need intermittent care, that your doctor has approved a plan of care for you, and that the face-to-face requirement was met.

To continue receiving home health care, your doctor should review and certify your plan or care every 60 days. A face-to-face meeting is not required for recertification.

Finally, for Medicare to cover your home health care, you must receive it from a Medicare-certified home health agency.

For any Medicare related questions, feel free to contact the State of Alaska Medicare Information Office at 800-478-6065 or 907-269-3680; our office is also known as the State Health Insurance Assistance Program (SHIP), the Senior Medicare Patrol (SMP), and the Medicare Improvements for Patients and Providers (MIPPA) program. If you are part of an agency or organization that assists seniors with medical resources, consider networking with the Medicare Information Office. Call us to inquire about our new Ambassador program.

Sean McPhilamy is a volunteer and Certified Medicare Counselor at the Alaska Medicare Information Office.