Am I Eligible for Medicare Coverage of Skilled Therapy Services as Part of Home Health Care?

Home health care includes a wide range of health and social services delivered in your home to treat illness or injury. Services covered by Medicare’s home health benefit include intermittent skilled nursing care, skilled therapy, and care provided by a home health aide. Depending on the circumstances, home health care will be covered by either Part A or Part B.

Medicare covers your home health care if:

  • You are homebound, meaning it is extremely difficult for you to leave your home and you need help doing so.
  • You need skilled nursing services and/or skilled therapy care on an intermittent basis.
    • Intermittent means you need care at least once every 60 days and at most once a day for up to three weeks. This period can be longer if you need more care, but your care needs must be predictable and finite.
    •  Medicare defines skilled care as care that must be performed by a skilled professional, or under their supervision.
      • Skilled therapy services refer to physical, speech, and occupational therapy
  • You have a face-to-face meeting with a doctor within 90 days before you start home health care, or the 30 days after the first day you receive care. This can be an office visit, hospital visit, or in certain circumstances a face-to-face visit facilitated by technology (such as video conferencing).
  • Your doctor signs a home health certification confirming that you are homebound and need intermittent skilled care. The certification must also state that your doctor has approved a plan of care for you and that the face-to-face meeting requirement was met.
    • Your doctor should review and certify your home health plan every 60 days. A face-to-face meeting is not required for recertification.
  • And, you receive care from a Medicare-certified home health agency (HHA).

You cannot qualify for Medicare home health coverage if you only need occupational therapy. However, if you qualify for home health care on another basis, you can also get occupational therapy. When your other home health needs end, you can continue receiving Medicare-covered occupational therapy under the home health benefit if you need it.

If you meet all the requirements, Medicare should pay for skilled care in your home and/or home health aide services. If you have had a three-day inpatient hospital stay and meet the above requirements, Medicare Part A may cover your home health services, including skilled therapy services. If you have not had a three-day inpatient hospital stay and still meet the above requirements, Medicare Part B may cover your home health services, including skilled therapy services. Under both Part A and Part B, Medicare will pay the full cost. If you have questions or experience billing issues, call 1-800-633-4227 (1-800-MEDICARE).

Read More: How Do I Appeal to Medicare Ending My Skilled Therapy Services?
Learn About: How Do I Appeal to Medicare About a Reduction to My Skilled Therapy Services?
Return to: Medicare In-Depth

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