Medicare
How Medicare covers home health
Home health is skilled care you can get in your home for an illness or injury. Medicare describes it as care to help you get better, keep your current condition or function, or slow your rate of decline. It is usually less expensive, and more convenient, than a hospital or skilled nursing facility.
This page restates Original Medicare rules in plain language. For the official wording, read Medicare.gov home health services. If you have a Medicare Advantage plan, check that plan.
Who is eligible
You must need part-time or intermittent skilled services, and you must be homebound. A doctor or other qualifying provider (such as a nurse practitioner) must assess you face-to-face and order the care. A Medicare-certified home health agency must provide it. New Horizon Home Health is that kind of agency.
You will not qualify if you need more than part-time or intermittent skilled care.
Homebound
Medicare says you must meet both of these:
- Leaving your home is not recommended because of your condition, or you have trouble leaving without help (a cane, wheelchair, walker, crutches, special transportation, or help from another person) because of an illness or injury.
- You are normally unable to leave your home, and leaving takes a lot of effort.
You may leave for medical treatment or for short, infrequent non-medical reasons, such as religious services. You can still get home health if you attend adult day care.
What Medicare covers
Skilled nursing
Medically necessary part-time or intermittent nursing, such as wound care, patient and caregiver education, intravenous or nutrition therapy, injections, and monitoring a serious or unstable condition.
Therapy
Physical therapy, occupational therapy, and speech-language pathology services when you meet Medicare's conditions.
Medical social services
Help with social or emotional concerns that interfere with treatment or recovery, when you are also getting skilled nursing or therapy.
Home health aide
Part-time help with walking, bathing or grooming, changing bed linens, and feeding, only if you are also getting skilled nursing or therapy.
What Medicare does not pay for
- 24-hour-a-day care at your home
- Home meal delivery
- Homemaker services such as shopping and cleaning that are unrelated to your care plan
- Custodial or personal care (bathing, dressing, or using the bathroom) when that is the only care you need
What you pay
- You pay nothing for covered home health services on Original Medicare.
- After you meet the Part B deductible, you pay 20% of the Medicare-approved amount for covered durable medical equipment.
- Before care starts, the agency should tell you how much Medicare is expected to pay, and tell you if Medicare will not pay for an item or service, and what you would owe.
- If a service may not be covered, you should receive an Advance Beneficiary Notice (ABN) first.