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November 21, 2023
Am I eligible for home health care?

I will soon be moving out of a skilled nursing facility (SNF). I may need additional physical therapy, but it will be difficult for me to leave my home. Am I eligible for home health care?

Posted March 29, 2021 by at United States in Medicare
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It sounds like you may be eligible for home health care under Medicare's home health benefit. Home health care includes a wide range of health and social services delivered in your home to treat illness or injury. Medicare covers your home health care if:

1.    You are homebound, meaning it is extremely difficult for you to leave your home and you need help doing so. The homebound requirement can be met in additional ways during the coronavirus public health emergency. You can be considered homebound if your physician certifies that you cannot leave your home because you are at risk of medical complications if you go outside, or if you have a suspected or confirmed case of COVID-19.

2.    You need skilled nursing services and/or skilled therapy care on an intermittent basis. Intermittent means you need care at least once every 60 days and at most once a day for up to three weeks. This period can be longer if you need more care, but your care needs must be predictable and finite. Medicare defines skilled care as care that must be performed by a skilled professional, or under their supervision. Skilled therapy services refer to physical, speech, and occupational therapy. You cannot qualify for Medicare home health coverage if you only need occupational therapy. However, if you qualify for home health care on another basis, you can also get occupational therapy. When your other home health needs end, you can continue receiving Medicare-covered occupational therapy under the home health benefit if you need it.

3.    You have a face-to-face meeting with a doctor within the 90 days before you start home health care, or the 30 days after the first day you receive care. This can be an office visit, hospital visit, or in certain circumstances a face-to-face visit facilitated by technology (such as video conferencing).

4.    Your doctor signs a home health certification confirming that you are homebound and need intermittent skilled care. The certification must also state that your doctor has approved a plan of care for you and that the face-to-face meeting requirement was met. Your doctor should review and certify your home health plan every 60 days. A face-to-face meeting is not required for recertification.

5.    And, you receive care from a Medicare-certified home health agency (HHA).
Medicare should pay for these services regardless of whether your condition Is temporary or chronic.
If you meet all the requirements, Medicare should pay for skilled care in your home and/or home health aide services. If you have questions, need help finding local HHAs, or experience billing issues, call 1-800-MEDICARE.


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Added: March 29, 2021