Medicare Benefits for Home

Who is eligible to get Medicare covered home health care and what services are covered?

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

  • Your doctor must prescribe that you need medical care at home and create a care plan.
  • You must need at least one of the following:
    • Intermittent Skilled Nursing Care
    • Intermittent Physical Therapy
    • Intermittent Occupational Therapy
    • Intermittent Speech Therapy
  • The home health agency must be Medicare-certified.
  • You must be homebound, or normally be unable to leave home unassisted. Homebound means that leaving home takes considerable and taxing effort.

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

  • Skilled nursing care on a part-time or intermittent basis.
  • Physical therapy, occupational therapy and speech therapy.
  • Home health aide services on a part-time or intermittent basis, as long as there is a skilled need.
  • Medical social services.
  • Certain medical supplies.
  • Durable medical equipment (wheelchair, walker, bedside commode, etc.)

Medicare is a useful benefit to have for skilled needs; however, there are services that Medicare will not cover. These include some of the following:

  • Personal care given by home health aides like bathing, dressing and assistance with bathroom needs when this is the only care needed.
  • Care needed 24 hours a day.
  • Homemaker services (shopping, cleaning, laundry, meal preparation, etc.).
  • Meals delivered to your home.

Private duty home care is an option for those whose needs exceed what Medicare will cover. Medicare only pays for intermittent visits, for a limited amount of time. If you need more than a couple hours of care each day, or if you have an ongoing need, we can help.

(adapted from www.medicare.org)

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