Original Medicare and Home Health Care

Original Medicare (Medicare Part A and/or Part B) will cover eligible home health services if you are considered homebound and need part-time or intermittent services.

To Qualify and be Considered Homebound:

  • You are having trouble leaving your home without some type of help due to an illness or injury. Examples of help would be the use of a cane, wheelchair, walker, crutches, special transportation, or help from another person.
  • Leaving your home isn’t recommended because of your medical condition.
  • You’re normally unable to leave your home because of the difficulty and effort required.

Generally speaking, “part-time or intermittent” means you may be able to receive skilled nursing care and home health aide services up to 8 hours a day, with a maximum of 28 hours per week. More frequent care for a short time may be allowed if your doctor or other health care provider determines that it is necessary.

Covered Home Health Services Under Original Medicare:

  • Medically necessary part-time or intermittent nursing care
  • Physical therapy
  • Occupational therapy
  • Language/Speech therapy
  • Medical social services
  • Part-time or intermittent home health aide care (only if you’re also getting skilled nursing care at the same time)
  • Injectable osteoporosis medications for women
  • Durable medical equipment
  • Medical supplies for use at home

Your health care provider is required to have a face-to-face visit with you before you can be certified as needing home health services. Your health care provider must order your medical care, and a Medicare-certified home health agency must provide your care.

What services are not covered:

  • 24-hour-a-day care in your home.
  • Meals delivered to your home.
  • Services such as shopping and cleaning that aren’t a part of your medical care plan.
  • Personal care that helps you with daily living activities like bathing, dressing, or using the bathroom, when this is the only type of care you need.

You’re not eligible for the home health benefits:

  • If you are needing more than part-time or “intermittent” care.
  • You are able to leave home for medical treatment or leave your home for non-medical reasons, like attending church services.
  • You can still get home health care if you attend adult day care.

If original Medicare is NOT your primary insurance, you will need to review your outline of coverage for your home health care benefits.