• Your doctor must decide that you need medical care at home, and make a plan for your care at home;
• You must need at least one of the following:
  • intermittent skilled nursing care,
  • physical therapy or speech-language therapy,
  • continue to need occupational therapy;
• You must be homebound. This means that you are normally unable to leave home unassisted. Being homebound means that leaving home is a major effort. When you leave home, it must be to get medical care, or for short, infrequent non-medical reasons such as a trip to get a haircut, or to attend religious services or adult day care.
• The home health agency caring for you must be approved by the Medicare program.

If you meet all four (4) of the conditions above, Medicare will help cover:

• Skilled nursing care on a part-time or intermittent basis. Skilled nursing care includes services and care that can only be performed safely and correctly by a licensed nurse (either a registered nurse or licensed practical nurse).
• Home health aide services on a part-time or intermittent basis. A home health aide does not have a nursing license. The aide provides services that give additional support to the nurse. These services include help with personal care such as bathing, using the toilet or dressing. These types of services do not need the skills of a licensed nurse. Medicare does not cover home health aide services unless you are also getting skilled care such as nursing care or other therapy. The home health aide services must be part of the home care for your injury or illness.
• Physical therapy, speech-language therapy and occupational therapy for as long as your doctor says you need it.
  • Physical therapy, which includes exercise to regain movement and strength to a body area, and training on how to use special equipment or do daily activities, like how to get in and out of a wheelchair or bathtub.
  • Speech-language therapy (pathology services), which includes exercise to regain and strengthen speech skills.
  • Occupational therapy, which helps you to become able to do usual daily activities by yourself. You might learn new ways to eat, put on clothes, comb your hair, and new ways to do other usual daily activities. You may continue to receive occupational therapy even if you no longer need other skilled care.
• Medical social services to help you with social and emotional concerns related to your illness. This might include counseling or help in finding resources in your community.
• Certain medical supplies, like wound dressings, but not prescription drugs.
• Certain medical equipment, such as a wheelchair or walker. Medicare usually pays 80% of the approved amount for some medical equipment.

Medicare does not pay for:

• 24-hour a day care at home.
• Prescription drugs (with a few exceptions -ask your doctor).
• Meals delivered to your home.
• Homemaker services like cleaning, laundry and shopping.
• Personal care given by home health aides, like bathing, using the toilet, or help in getting dressed when this is the only care you need.

For more information about Medicare coverage of home health care, call 1-800-MEDICARE, or visit www.medicare.gov and click on “Publications” to read Medicare and Home Health Care.

Posted: 10/30/2003

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