Medicare and Home Health Care
REVIEW OF MEDICARE
You can use your home health benefits under Part A and/or Part B if you meet all of these conditions:
• You must be under the care of a doctor, and you must be getting services under a plan
of care established and reviewed regularly by a doctor.
• You must need, and a doctor must certify that you need, one or more of these:
– Intermittent skilled nursing care (other than drawing blood)
– Physical therapy
– Speech-language pathology services
– Continued occupational therapy
• The home health agency caring for you is approved by Medicare (Medicare certified).
• You must be homebound, and a doctor must certify that you’re homebound. To be homebound means either of these is true:
– You have trouble leaving your home without help (like using a cane, wheelchair,
walker, or crutches; special transportation; or help from another person) because of an illness or injury; or leaving your home isn’t recommended because of your
– You’re normally unable to leave your home, but if you do, it requires a major effort.
You may leave home for medical treatment or short, infrequent absences for non-medical reasons, like an occasional trip to the barber, a walk around the block or a drive, or a family reunion, funeral, graduation, or other infrequent or unique event. You can still get home health care if you attend adult day care or religious services.
A doctor, or certain health care professionals who work with a doctor (like a nurse practitioner), must document that they’ve had a face-to-face encounter with you (like an appointment with your primary care doctor) within required timeframes and that the encounter was related to the reason you need home health care.
What Original Medicare covers
Note: Home health services may also include medical social services, part-time or intermittent home health aide services, medical supplies for use at home, durable medical equipment (see pages 27–28), or injectable osteoporosis drugs.
For more information on home health care, visit Medicare.gov to print or view the booklet, “Medicare & Home Health Care.”
In 2018, you pay NOTHING for all covered home health visits. You pay 20% of the Medicare-approved amount, and the Part B deductible applies, for Medicare-covered medical equipment.
Osteoporosis drugs for Women
Part A and Part B help pay for an injectable drug for osteoporosis if you’re a woman who’s eligible for Part B, meet the criteria for Medicare home health services, and have a bone fracture that a doctor certifies is related to postmenopausal osteoporosis. Your doctor must also certify that you’re unable to learn to give yourself the drug by injection, and that family members and/or caregivers
are unable or unwilling to give you the drug by injection. Medicare covers visits by a home health nurse to inject the drug.
In 2018, you pay 20% of the Medicare-approved amount for the cost of the drug, and the Part B deductible applies. You pay nothing for the home health nurse visit to inject the drug.