Medicare and Home Health Care

Home health agencies that are certified by Medicare have met the federal requirements for patient care and management and can provide both Medicare and Medicaid services.

Although Medicare provides the largest amount of coverage for home-care services, it has certain limitations.

• Medicare should not be relied upon to pay for long-term care or personal and household management, but may be of assistance for people suffering acute, short-term illnesses or injuries, such as a fractured bone or minor stroke.

• Medicare generally pays for some or all of home health care costs when a patient needs skilled nursing or skilled therapy (including physical therapy and speech language pathology therapy) in their own home on a regular basis.

• To qualify for Medicare benefits, patients must be homebound, eligible for Medicare and under a doctor’s care.

• Doctors must recommend the “medically reasonable and necessary” services as part of the patient’s health care plan. Services must be carried out with a doctor’s supervision.

• Home health care agencies used by the patient must be Medicare-certified.

To find a Medicare-certified home health care agency, ask your doctor, nurse or a hospital discharge supervisor or any other medical or social service professional who helps you for recommendations. You can also look in your yellow pages under “Home Health Care.”

For more information about Medicare and home health care, call 1-800-MEDICARE (TTY/TDD: 1-877-486-2048 for the speech and hearing impaired) or visit www.medicare.gov.

If you are not eligible for Medicare and need home health care, you may want to look into coverage provided by Medicaid, the Older Americans Act, and the Veteran’s Administration, as well as any private insurance you might hold.