Medicare Home Health Benefits

If you have Medicare, you can use your home health benefits if you meet the following conditions:

  1. You must be under the care of a doctor, and you must be getting services under a plan of care established and reviewed regularly by a doctor.
  2. You must need, and a doctor must certify that you need, one or more of the following.
    • Intermittent skilled nursing care
    • Physical therapy
    • Speech-language pathology services
    • Continued occupational therapy
  3. The home health agency caring for you must be approved by Medicare (Medicare-certified.  Med Plus HealthCare is Medicare-certified.
  4. You must be homebound, and a doctor must certify that you’re homebound.  To be homebound means the following:
    • Leaving your home isn’t recommended because of your condition.
    • Your condition keeps you from leaving home without help (such as using a wheelchair or walker, needing special transportation, or getting help from another person).
    • Leaving home takes a considerable and taxing effort.

A person may leave home for medical treatment or short, infrequent absences for non-medical reasons, such as attending religious services.  You can still get home health care if you attend adult day care, but you would get the home care services in your home.

If you meet the conditions above, Medicare pays for your covered home health services for as long as you’re eligible and your doctor certifies you need them.  If you need more than part-time or “intermittent” skilled nursing care, you aren’t eligible for the home health benefit.

In Original Medicare, Medicare pays your Medicare-certified home health agency one payment for 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.

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