Navigating Medicare coverage for home health care can be complex. This guide helps you understand what’s covered, eligibility requirements, and how to access the care you need.
Medicare Coverage Types
Medicare Part A (Hospital Insurance)
- Post-hospital care
- Skilled nursing services
- Physical therapy
- Occupational therapy
- Speech therapy
- Medical social services
Medicare Part B (Medical Insurance)
- Durable medical equipment
- Medical supplies
- Preventive services
- Some outpatient services
- Part-time skilled care
Eligibility Requirements
To qualify for Medicare home health coverage:
- Must be under doctor’s care
- Need skilled care on part-time basis
- Be homebound as certified by doctor
- Require skilled nursing, physical therapy, speech therapy, or continued occupational therapy
- Receive care from Medicare-certified agency
- Have a documented face-to-face encounter with doctor
Service Limitations
Understanding coverage limits:
- Part-time or intermittent care only
- Maximum 8 hours per day
- Maximum 28 hours per week
- Some exceptions for limited periods
- Must maintain documented improvement
- Requires ongoing eligibility verification
Required Documentation
Essential paperwork includes:
- Physician certification
- Face-to-face documentation
- Plan of care
- Health status updates
- Service delivery records
- Progress notes
- Outcome measurements
- Recertification documents
Common Misconceptions
Medicare does NOT cover:
- 24-hour home care
- Meal delivery
- Homemaker services
- Personal care only
- Custodial care when that’s the only care needed
- Long-term continuous care
Finding Medicare-Certified Agencies
Through homecarelist.org, you can:
- Filter for Medicare-certified providers
- Compare coverage acceptance
- Verify certification status
- Review service offerings
- Check quality ratings
- Schedule assessments
- Understand costs
- Start care planning
Maximizing Your Coverage
Tips for optimal coverage:
- Follow doctor’s orders exactly
- Maintain required documentation
- Meet all eligibility criteria
- Use certified providers
- Track service hours
- Report changes promptly
- Keep detailed records
- Schedule regular reviews
Additional Resources and Support
Access help through:
- Medicare hotline
- Senior organizations
- Care coordinators
- Social workers
- Insurance counselors
- Medicare.gov website
- Local aging services
- Healthcare advocates
Starting Home Health Services
Steps to begin:
- Get doctor’s referral
- Choose Medicare-certified agency on homecarelist.org
- Complete eligibility assessment
- Review coverage details
- Develop care plan
- Schedule services
- Monitor progress
- Maintain documentation
Ready to find Medicare-certified home health care? Visit homecarelist.org to compare qualified providers in your area.
Need help understanding Medicare coverage? Contact us at homecarelist.org for assistance in finding Medicare-certified agencies that meet your care needs.
Medicare.gov: “Home Health Services” https://www.medicare.gov/coverage/home-health-services
This official Medicare resource provides authoritative information about home health coverage and benefits.