Who is eligible?

If you have Medicare, you can use your home health benefits if you meet all the following conditions:
1.) You must be under the care of a doctor; 2.) You must be receiving services under a care plan which has been established and is reviewed regularly by a doctor.

You must need, and a doctor must certify that you need, one or more of the following:

  • Intermittent skilled nursing care
  • Physical therapy
  • Speech-language pathology services
  • Continued occupational therapy

The home health agency caring for you must be approved by Medicare (Medicare-certified).

You must be homebound, and a doctor must certify that you’re homebound. To be homebound means the following:

  • Leaving your home isn’t recommended because of your condition
  • Your condition keeps you from leaving home without help (such as using a wheelchair or walker, needing special transportation, or getting help from another person)
  • Leaving home takes a considerable and taxing effort

A person may leave home for medical treatment or short, infrequent absences for non-medical reasons, such as attending religious services. You can still get home health care if you attend adult day care, but you would get the home care services in your home.

Eligibility is also based on the amount of services you need.

If you meet the conditions above, Medicare pays for your covered home health services for as long as you’re eligible and your doctor certifies you need them. If you need more than part-time or “intermittent” skilled nursing care, you aren’t eligible for the home health benefit.  That is, should you require constant nursing surveillance or medical assistance to remain in your home, you are not covered under Medicare.

To decide whether you’re eligible for home health care, Medicare defines part-time or “intermittent” as skilled nursing care that’s needed or given on fewer than 7 days each week or less than 8 hours each day over a period of 21 days (or less) with some exceptions in special circumstances.

Hour and day limits may be extended in exceptional circumstances when your doctor can predict when your need for care will end.

(My acknowledgments to the Medicare website for much of the above referenced information.)