Original Medicare (Parts A & B): Part A: Home Health Services

Intermittent skilled nursing, therapy, social work, and home health aide services provided in the home to support recovery or address functional decline.

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Cost
$0 for home health services; 20% of Medicare-approved amount for durable medical equipment (DME)
Prior Authorization Required
No, but you must meet homebound criteria
Provider Referral or Order Required
Yes

How To Receive

Details on how to apply

  1. Obtain an order from a provider for home health care.

  2. Choose a Medicare-certified home health agency from which to receive services.

  3. Schedule an intake and start-of-care (SOC) visit.

    • These are typically conducted in the home by an RN, though can also be conducted by a physical therapist (PT).

    • Intake is generally done over the phone, though SOC is done in person and can take 2-3 hours to complete.

  4. Together with the home health care professional, develop a plan of care and associated care goals.

    • The plan of care will include the services required (nursing, therapy, etc.) and a visit schedule (typically 1-3 times per week, per service).

  5. Participate in visits, as scheduled, and complete the therapies recommended.

  6. Home health care ends when the plan of care goals are achieved, or when there is no more progress towards goals.

For more information on Medicare benefits and coverage, call 1-800-MEDICARE (1-800-633-4227) or visit the Medicare Benefits Website. TTY users, call 1-877-486-2048.

Availability
As certified by a provider

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Medicare covers home health services under Part A and/or Part B. Medicare covers medically necessary part-time or intermittent skilled nursing care, physical therapy, speech-language pathology services, or continued occupational therapy services. Home health services may also include medical social services, part-time or intermittent home health aide services, durable medical equipment, and medical supplies for use at home.

"Part-time or intermittent" means your loved one may be able to get skilled nursing care and home health aide services if they are [rovided for less than 8 hours each day or less than 28 hours each week (or up to 35 hours a week in some limited situations).

A provider must see your loved one face-to-face before certifying that they need home health services. A provider must order the care, and a Medicare-certified home health agency must provide it.

Medicare covers home health services as long as your loved one needs part-time or intermittent skilled services and as long as they are "homebound," which means:

Your loved one pays nothing for covered home health services. However, for Medicare-covered durable medical equipment (DME), they are responsible for 20% of the Medicare-approved amount and the Part B deductible applies.

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