How to get home health?

Medicare-covered home health services can be a crucial part of restoring someone to their prior level of functioning after a hospitalization. They can be ordered for skilled nursing or physical occupational or speech therapy. They can also be ordered without a hospitalization for someone in the community who has skilled needs and is homebound. Here’s exactly how a Medicare beneficiary can qualify.

  • To qualify for home health services under Original Medicare (Medicare Advantage plans may require some authorization), the beneficiary must meet ALL of the following conditions: 

    1. Be Under the Care of a Doctor

    • A doctor (or an allowed provider like a nurse practitioner) must: 

    • Order the home health care 

    • Certify that the patient needs it 

    • Regularly review the care plan 

    2. Need One or More of These Services:

    • Skilled nursing care (intermittent, not 24/7) 

    • Monitoring vital signs 

    • Wound care 

    • Management and education for a new or uncontrolled diagnosis 

    • Physical therapy

    • Occupational therapy

    • Speech-language pathology services

    Intermittent means care is needed up to several days a week and patient can safely be at home on their own or with caregivers. 

    3. Be Homebound

    • Leaving home must be: 

    • A major effort requiring assistance due to illness or injury 

    • Only done occasionally, like for: 

    • Medical appointments 

    • Religious services 

    4. Use a Medicare-Certified Home Health Agency

    • The services must be provided by an agency that is certified by Medicare. 

    • Skilled nursing care (wound care, injections, monitoring of vital signs, education to stabilize chronic illness) 

    • Physical, occupational, and speech therapy 

    • Home health aide (for personal care like bathing, dressing, etc.)—only if skilled services are also being provided and may vary between agencies (usually for 30-60 day period)

    • Medical social services 

    • Medical supplies (like wound dressings) 

    • Durable medical equipment (DME), like a walker or wheelchair (80% coverage under Part B) 

    • Long term support services 

    • Meal delivery 

    • Homemaker services (cleaning, laundry) if that’s the only help needed 

    • Personal care (like bathing) if not combined with skilled care - and only short term

    • You can ask the doctor directly to evaluate whether the person qualifies. 

    • The doctor must complete a face-to-face visit within 90 days before or 30 days after starting home health. This may be done via telehealth. 

    • You have the right to choose the home health agency—just make sure it’s Medicare-approved. 

    • Hospitals or physicians may have a list of preferred agencies they believe are high quality 

    • If your loved one has gotten weak or has a new diagnosis where education would be helpful (Heart failure, diabetes or kidney failure for example) ask their doctor if they qualify for PT or skilled services to strengthen and/or enable them (or you) to better care for their health