Home Health Care
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
■ Physical therapy
■ Speech-language pathology services
■ Continued occupational therapy
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. To be homebound means:
■ You have trouble leaving your home without help (like using a cane, wheelchair, walker, or crutches; special transportation; or help from another person) because of an illness or injury, or leaving your home isn’t recommended because of your condition.
■ You’re normally unable to leave your home, but if you do it requires a major effort. You may leave home for medical treatment or short, infrequent absences for non-medical reasons, like an occasional trip to the barber, a walk around the block or a drive, or attendance at a family reunion, funeral, graduation,
6 Medicare Coverage of Home Health Care or other infrequent or unique event. You can still get home health care if you attend adult day care or religious services.
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 timeframes and that the encounter was related to the reason you need home health care.