A Quick Look at Medicare Home Health Benefits

By Kendra Knouff
eMedicareSupplements Senior Writer

Medicare beneficiaries are given the option to receive home health care for an injury or illness. The Medicare home health benefit allows you to receive the same skilled care in your home that you would normally get in a clinic, skilled nursing facility or hospital. Home health services are not any less effective than the care you would receive in a professional facility, and they carry the added benefit of often being cheaper and quite convenient.

According to Medicare, you must meet certain eligibility requirements for home health benefits.

• You must be under a physician’s care and receiving services that are ordered and reviewed by your physician under an established care plan.
• Your condition is such that you cannot leave your home without assistance and your physician recommends that you be homebound.
• Your physician certifies that you require occupational, physical or speech therapy or skilled nursing care.
• The amount of services needed are "intermittent" or part-time in nature.
• You are receiving care from a home health agency that is Medicare-approved.

If you are eligible to receive home health benefits, you are covered for 35 hours of skilled care per week. The equipment and supplies related to your care are also covered, as well as any social services you may need. Medicare will not pay, however, for meal delivery, 24-hour care or household services such as shopping or errands. It also will not pay for personal care like bathing and dressing if that is the only care needed.

Medicare beneficiaries are eligible for these services regardless of whether their benefits derive from a Medicare Advantage plan or original Medicare. You will not need to pay anything for the services, but you will be billed for 20 percent of medical supplies or equipment needed. Some Medicare supplement plans cover this expense.

If the home health agency needs to introduce equipment or services that are not completely covered by Medicare, they are required to give you a Home Health Advance Beneficiary Notice apprising you of your coverage obligations.