What is Medicare Home Care?

The terms Home Care, Home Health and In Home Care, can be confusing. Often, they are used interchangeably, but they all have slightly different meanings. Depending on your insurance and level of need, they may not all function the same way in your home or, provide the level of service that you need in the home. It is helpful to start with defining the terms most commonly used today.

Medicare Home Health Care

Medicare pays for you to get certain health care services in your home if you meet certain eligibility criteria, provided you have original or traditional Medicare and not an Advantage Plan and if the services are considered reasonable and necessary for the treatment of your illness or injury. This is known as the Medicare home health benefit.

Who is eligible for Medicare Home Health?

If you have Medicare, you can use your home health benefits if you meet all the following conditions:

  1. 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.
  2. You must need, and a doctor must certify that you need, one or more of the following:
  3. Intermittent skilled nursing care
  4. Physical therapy
  5. Speech-language pathology services
  6. Continued occupational therapy
  7. The home health agency caring for you must be approved by Medicare (Medicare-certified).
  8. You must be homebound, and a doctor must certify that you’re homebound.

To be homebound means the following:

  1. Leaving your home isn’t recommended because of your condition.
  2. Your condition keeps you from leaving home without help (such as using a wheelchair or walker, needing special transportation, or getting help from another person).
  3. Leaving home takes a considerable and taxing effort. A person may leave home for medical treatment or short, infrequent absences for non-medical reasons, such as attending religious services, or personal events such as a wedding.

You CAN NOT receive Home Health Care and Outpatient Therapy at the same time

What is intermittent skilled care?

If you need more than part-time or “intermittent” skilled nursing care, you aren’t eligible for the home health benefit. To decide whether you’re eligible for home health care, Medicare defines part-time or “intermittent” as skilled nursing care that’s needed or given on fewer than 7 days each week or less than 8 hours each day over a period of 21 days (or less) (some exceptions apply see Medicare.gov for more information)

Medicare DOES NOT PAY OR COVER the following:

  1. 24-hour-a-day care at home. One of the most common misconceptions professionals hears, is “Medicare will cover all my needs at home”. Remember, Medicare, in all forms, is designed for episodic coverage, not permanent long term care and assistance needs.
  2. Meals delivered to your home.
  3. Homemaker services like shopping, cleaning, and laundry when this is the only care you need, and when these services aren’t related to your skilled nursing plan of care.
  4. Personal care given by home health aides like bathing, dressing, and using the bathroom when this is the only care you need and these services aren’t related to your skilled nursing plan of care.
  5. Transportation services not related to your skilled need.
  6. Companion services for visits and emotional support

Information contained in this document was prepared and or used with authors’ permission, if applicable, by Posada Life. All material, copyright and protected content is reprinted with permission from original author, providing appropriate citation or is intended for general educational purposes only. Content is not intended to diagnosis or treat any specific condition. Posada Life not responsible for content or materials provided by third parties or government agencies. U.S Government cited content provided by: National Institute on Aging (https://www.nia.nih.gov/), National Institute for Health (https://www.nih.gov/), U.S. Department of Health (http://www.hhs.gov/), National Institute for Senior Health (https://nihseniorhealth.gov/).