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Home / Medicare Home Health Care
A GUIDE TO COVERAGE AND ELIGIBILITY
Understanding Medicare
Home Health Care
Medicare may cover eligible home health services when applicable coverage requirements are met. Learn about common eligibility factors, skilled services, provider requirements, and the steps involved in beginning care at home.
This page provides general information and does not determine individual eligibility or guarantee coverage.
Eligibility is individual
Coverage depends on the person’s needs, provider documentation, plan of care, and applicable Medicare requirements.
CARE AT HOME
What Medicare home health care means
Home health care includes certain health services delivered in a person’s home for an illness or injury. Depending on the individual’s needs and whether Medicare’s requirements are met, services may help with recovery, maintaining function, or slowing a decline.
This is different from around-the-clock home care or personal care by itself. Visit the official Medicare home health services page for current federal information.
COMMON ELIGIBILITY FACTORS
Who may qualify for Medicare home health care
Eligibility is determined for each person. The following are common requirements, not a coverage decision.
01
A need for skilled care
The person may need part-time or intermittent skilled nursing, physical therapy, speech-language pathology, or qualifying continued occupational therapy.
02
Homebound status
Medicare generally requires that the person meet its definition of homebound, including that leaving home is difficult and requires considerable effort or assistance.
03
A provider’s involvement
A doctor or other allowed practitioner must evaluate the need for home health care, order services, and establish or oversee the plan of care as required.
04
An eligible care arrangement
Services must be medically necessary, included in the plan of care, and furnished in accordance with Medicare’s applicable home health requirements.
SKILLED SERVICES AT HOME
Services Medicare may cover when requirements are met
The services ordered for one person may be different from those ordered for another. Medical necessity, eligibility, and the individualized plan of care guide what may be covered.
Skilled nursing
Medicare may cover medically necessary, part-time or intermittent nursing services that require the skills of a licensed nurse and are included in the plan of care.
Physical therapy
Physical therapy may be covered when skilled treatment is reasonable and necessary to improve or maintain function or help prevent decline.
Occupational therapy
Occupational therapy may be included when Medicare’s eligibility rules are met and the service is ordered as part of the person’s plan of care.
Speech therapy
Speech-language pathology services may be covered when skilled care is needed for communication, cognition, or swallowing concerns related to an illness or injury.
Home health aides
Part-time or intermittent aide services may be covered when a person is also receiving qualifying skilled home health services and the aide care supports the plan of care.
Wound care
Skilled wound care may be covered when it is medically necessary, ordered, and provided under an eligible home health plan of care.
A SKILLED NURSING SERVICE
Wound care at home
Medicare identifies certain wound care, including care for pressure sores or surgical wounds, as an example of skilled nursing that may be covered when applicable requirements are satisfied.
The appropriate services and visit schedule depend on the wound, provider orders, nursing assessment, medical necessity, and individualized plan of care.
PROVIDER INVOLVEMENT
Physician and provider requirements
Provider documentation is an important part of determining whether home health services meet Medicare requirements.
Face-to-face encounter
A doctor or allowed practitioner generally must complete and document a qualifying face-to-face encounter related to the need for home health care within Medicare’s required timeframe.
Order and certification
The provider must order the home health services and certify that the individual meets the applicable requirements for the Medicare home health benefit.
Individualized plan of care
Care must follow a provider-established and periodically reviewed plan that identifies the needed services, visit frequency, and treatment goals.
GETTING STARTED
How to begin home health services
01
Speak with your provider
Discuss whether home health care may be appropriate for your condition, needs, and recovery goals.
02
Contact our agency
Ask about current service availability, the referral process, and which information may be needed to begin a review.
03
Complete the referral review
The provider’s orders and clinical information are reviewed, and an assessment may be arranged when appropriate.
04
Confirm the next steps
Eligibility, coverage, agency acceptance, and the care plan must be confirmed before services begin.
A conversation is not a coverage decision
Contacting the agency does not guarantee eligibility, coverage, acceptance, or a start-of-care date. Those decisions depend on the applicable requirements and the individual referral review.
QUESTIONS ABOUT THE NEXT STEP?
Talk with our team about
home health care.
Contact The Home Health Agency to discuss the referral process, requested services, and current availability. We can explain the information needed for review without making an advance coverage determination.