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Do I Have Medicare Home Health Benefits?

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Medicare home health benefits are covered in specific, limited situations. This might include skilled nursing care or therapy services that you receive at home.

Learn how Medicare home health benefits are covered through Original Medicare and Medicare Advantage.

Medicare home health benefits

Medicare home health benefits through Medicare Part A and/or Part B may include:

  • Therapy services, such as physical therapy, occupational therapy, or speech-language pathology
  • Part-time or irregular skilled nursing care
  • Medical social services
  • Part-time or irregular home health aide care
  • Durable medical equipment
  • Injectable osteoporosis drugs
  • Medical supplies to be used at home

This may not be a complete list. Your home health care is typically administered through a home health agency. 

Eligibility for Medicare home health benefits

If you’re enrolled in Medicare Part A and/or Part B, you may be eligible for Medicare home health benefits if you meet all of the following criteria:

  • You’re being treated by a doctor who supervises and regularly reviews your treatment plan.
  • You’re homebound, which has been certified by a doctor.
    • Keep in mind that you usually can’t get Medicare home health benefits if you need more than part-time or irregular skilled nursing care.
    • You still may be eligible for Medicare home health benefits if you go to adult day care. You may also still be eligible if you need to leave your home for medical care, or if you leave for non-medical reasons, but the visits are short and irregular.
  • Your doctor has certified that you need one or more of the following types of care:
    • Irregular skilled nursing services (other than having your blood drawn)
    • Therapy services (see below for more details)

How Medicare home health benefits work for therapy services

If you need therapy services, Medicare home health benefits are only covered only in very specific situations. As mentioned, your doctor must certify that you need therapy services, and that therapy must be the type that can only be done by a skilled therapist. The amount and timeframe of your therapy must be “reasonable” by Medicare standards.

One of the following must also be true for you to get Medicare home health benefits:

  • Your condition should be expected to get better in a “reasonable and generally predictable” timeframe.
  • You must need a therapist to create a program to treat your condition in a safe and effective manner.
  • You need a qualified therapist to conduct maintenance therapy for you in a safe and effective manner. You must get the therapy through a Medicare-certified home health agency.

Medicare home health benefits that aren’t covered

Medicare home health benefits don’t include everything. If you have Original Medicare (Part A and Part B) you generally won’t be covered for:

  • Meal deliveries
  • Homemaker services (such as shopping or cleaning) when unrelated to your treatment
  • Personal care (such as bathing or help getting dressed) if this is the only type of care you need
  • 24/7 care from your home

However, as of 2019, Medicare Advantage plans may extend supplement benefits to include meal delivery, and transportation for non-medical needs like grocery shopping. You have to qualify for the specific benefit.

Other Medicare home health benefits under Medicare Advantage

Medicare Advantage (Part C) must offer at least the same level of coverage as Original Medicare. You’ll get at least the same Medicare home health benefits through your Medicare Advantage plan as you would under Original Medicare.

Medicare Advantage plans may also cover extra benefits, such as prescription drugs, wellness programs, or routine vision and dental. Medicare Advantage plans may continue to offer new supplement benefits, like meal delivery, that Original Medicare typically doesn’t cover.

Want to compare benefits among different Medicare Advantage plans? Start browsing right away by entering your zip code into the plan finder tool.

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