About the Medicare Home Health Benefit

If you are a Medicare beneficiary (who is enrolled in Part A, Part B, or both), Medicare will help cover your home health care, if you meet the following four (4) conditions:

• A doctor must decide that you need skilled care in your home and prescribe or order home care. The doctor, patient, family member, or other caregiver then contacts a home health agency. The home health agency goes to the patient's home, makes an assessment and develops a plan of care, which must be approved and signed by the patient's physician; and
• You must need at least one of the following services: part-time or intermittent skilled nursing care or physical therapy, speech-language services, and
• You must be homebound. This means that you are normally unable to leave home without considerable and taxing effort, and, when you do leave home, you require the assistance of another person or an "assistive" device, such as a walker, cane, or wheelchair. You may leave home at any time for medical care, approved adult day care or religious services. Absences from home for any other reason must be infrequent or for short periods of time, such as family events or outings; and
• You must receive your services from a home health agency that is "certified" (or approved) by Medicare.

If you meet all four of the conditions above, Medicare will help cover:

• Skilled nursing. This is care that can only be delivered safely by a registered nurse, or a licensed practical nurse under the supervision of a registered nurse. It is care like injections and complex wound care.
• Home health aide services. These services include help with personal care such as bathing, using the toilet, or dressing. Medicare does not cover them unless you are also getting skilled care such as nursing or other therapy.
• Therapy. This includes physical therapy, speech-language services and occupational therapy. Your doctor must say you need these types of care.
• Medical social services. This is counseling to help with social and emotional concerns related to your illness.
• Certain medical supplies. This includes things like wound dressings and ostomy supplies.
• Certain durable medical equipment. This includes wheelchairs, hospital beds, oxygen and walkers (not all home health agencies provide equipment — and, if they do, you will be responsible for paying 20% of the cost of these items).

Medicare does not pay for:

• 24-hour per day care in the home.
• Prescription drugs (with a few exceptions — consult your physician).
• Meals delivered to your home.
• Homemaker services like cleaning, laundry and shopping.

If you need more information about Medicare enrollment or home care call 1-800-MEDICARE.