What Is the Medicare Home Health Benefit?

by Steve Gross

Overview

The Medicare Part A Home Health benefit provides an opportunity for you to recover from an injury or illness or adjust to a long-term disability in the comfort of your own home. Home health care benefits are available when your doctor believes --- and Medicare agrees --- that you can receive the care you need at home on a part-time basis rather than in a more expensive medical facility on a full-time basis.
Eligibility

The home health care benefit is available when your doctor decides you need home medical care. Medicare will agree with your doctor only when his plan for you involves part-time skilled care, physical therapy, speech pathology services or continued "occupational" therapy. "Occupational" therapy refers to regaining the skills you need to care for yourself on a daily basis and not for preparing yourself to go to work. You also need to be "homebound" --- that is, normally unable to leave home without assistance. Finally, you must use a Medicare-approved home health agency and your care must be part-time.

Part-Time Care

Medicare requires that home health service agencies deliver only part-time (intermittent) skilled nursing and nurses' aide services. The system defines part-time as services delivered with a combined total of less than eight hours a day or 28 hours a week for up to three weeks.
What's Covered?

Original Medicare covers six home-care activities. Medicare will pay for skilled nursing care. It also will pay for a home health aide but only while you are receiving skilled nursing care. Medicare covers physical therapy (including speech-language pathology) and occupational therapy plus both medical social services and the medical supplies used in your care.
What's Not Covered

Medicare doesn't cover full-time home care, delivered meals, homemaker services (shopping, cleaning and laundry, for example) and the cost of home health aides when you are not under skilled care.
Costs

Medicare pays your home health agency the amount the agency previously has agreed to accept as full payment for the service. Medicare bases its payment on 60-day units of care that it calls "episodes of care." Medicare allows the home care agency to charge you (or your supplemental insurer) only the 20 percent co-payment for any durable equipment it purchases for you (a wheelchair, for example). Consequently, you have to pay only for any medical supplies Medicare doesn't cover and the 20 percent co-payment for medical equipment.