Medicare Home Health Care - The Basics

Medicare Home Health Care - The Basics

The system can be confusing to many, but understanding the basics regarding what will be paid for home health care is important to many seniors,

especially those focusing on aging in place or living at home. We'll start with the basics.

Designed for individuals over 65 years of age, and is run by CMS (Centers for Medicare and Medicaid Services). Options and plans help pay for hospitalization, doctor's services, home health care, hospice care and rehab care in a variety of scenarios as long as basic stipulations are met.

Requirements include:

  • Services must be provided by a certified agency, company, hospital or other facility, except in emergencies scenarios.
  • Services are generally provided within the United States, although in some situations and emergency cases, benefits may be paid to services rendered in locations such as Mexico or Canada.
  • Services must be medically necessary as per requirements. This means that services must be ordered by a physician.
medicare home health care

Home Health Care

Home health care is medical treatment or service received in a senior's home, apartment, or other facility. Home health care is basically divided into two categories:

  • Skilled care
  • Custodial care

Skilled care is defined as treatment, either part time, occasional, or based on need, of nurses aides, therapists and nurses. The services must be prescribed by a doctor. Services for skilled care must be performed by a home health care agency that has been certified.

Custodial care is defined as that which is often offered for help with daily activity needs such as bathing, eating, dressing and grooming. These services are generally not covered by Part A, which is considered hospital or hospitalization insurance.

Who's Eligible For Home Health Care Coverage?

In order to be eligible for home health care, the senior must first have Medicare coverage.

Any services rendered through Home Health Care Agencies must be directed within a plan of care created and reviewed on a regular basis by the senior's doctor.

In addition, the doctor must send a document certifying that one or more of the following needs are required:

  • Speech language pathology services
  • Physical therapy
  • Intermittent skilled nursing care
  • Continued occupational therapy

In addition, the system stipulates that the person receiving the home health care is home bound, with the doctor providing certification that the senior is home bound, meaning that it's not recommended that the senior travel outside of the home environment for safety or medical reasons, and that their condition prevents them from leaving the home environment without special transportation, another person to help with mobility, or without durable medical equipment such as walkers or wheelchairs.

medicare home health care

It also must be documented by the physician that leaving the home environment will place extreme hardship on the individual. This doesn't mean that the person can never leave their home for family visits, religious services, or adult day care needs, but that the senior must be able to prove difficulty or disability that prevents them from traveling or receiving - on a regular basis - outside help with medical or therapy care.

How Much Help Will You Receive?

Home health care service eligibility will also depend on what you need. Interment and skilled nursing care is defined by Medicare as less than seven days a week and less than 8 hours a day over a 21-day period of time. Ongoing or extended needs will be determined by the senior's physician.

What It Doesn't Cover

While this covers skilled nursing care in home health care scenarios, they don't generally cover:

  • 24-hour care
  • Meal delivery

* Services performed by home health aides, such as dressing or bathing or toileting when these are the only types of services that are needed.

* Laundry, cleaning or shopping services when this is the only type of service needed or if such services aren't necessary based on the senior's plan of care.


Contact or log on to for more information regarding Home Health Care Services. Before choosing a home health care provider, determine what kind of services may be needed,

how often those services will be needed, and the type of medical equipment that may be necessary to offer quality based care.

Medicare and Medicaid Page

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