What is Home Health?
Home Health provides skilled services, that include
Nursing Care,
Physical Therapy
Occupational Therapy
Speech Therapy
Medical Social Services,
Home Health Aides.
The agency will send a licensed professional to assess home health needs The home health staff provides and helps coordinate the care and/or therapy your doctor orders. Along with the doctor, home health staff create a plan of care, which is a written plan for your care. It tells what services you will get to reach and keep your best physical, mental, and social well-being. The home health staff keeps your doctor up-to-date on how you are doing and updates your plan of care as needed, as authorized by your doctor.
Who’s eligible?
If you have Medicare, you can use your home health benefits if:
1. You’re under the care of a doctor, and you’re getting services under a plan of care established and reviewed regularly by a doctor.
2. You need, and a doctor certifies that you need, one or more of these:
Intermittent skilled nursing care (other than drawing blood)
Physical therapy
Speech-language pathology services
Continued occupational therapy See pages 8–9 for more details on these services.
3. The home health agency caring for you is approved by Medicare (Medicare certified).
4. You’re homebound, and a doctor certifies that you’re homebound.
5. As part of your certification of eligibility, a doctor, or certain health care professionals who work with a doctor (like a nurse practitioner), must document that they’ve had a face-to-face encounter with you (like an appointment with your primary care doctor) within required time frames and that the encounter was related to the reason you need home health care.
How Medicare pays for home health care
Medicare pays your Medicare-certified home health agency one payment for the covered services you get during a 60-day period. This 60-day period is called an “episode of care.” The payment is based on your condition and care needs.
Getting treatment from a home health agency that’s Medicare certified can reduce your out-of-pocket costs. A Medicare certified home health agency agrees to:
Be paid by Medicare
Accept only the amount Medicare approves for their services
Medicare’s home health benefit only pays for services provided by the home health agency. Other medical services, like visits to your doctor or equipment, are generally still covered by your other Medicare benefits.
Look in your “Medicare & You” handbook for information on how these services are covered under Medicare. To view or print this booklet, visit Medicare.gov/publications. You can also call 1-800-MEDICARE (1-800-633-4227) if you have questions about your Medicare benefits. TTY users can call 1-877-486-2048.