Dear Marci,

I have Original Medicare. I am recovering from a stroke, and I have a lot of trouble getting around, including trouble leaving my home. I’m also in need of a lot of physical and occupational therapy, as well as speech/language pathology.  Can I get care in my home covered by Medicare?

-San (Kailua, HI)

Dear San,

Medicare covers some home health care if you meet certain conditions for eligibility. Home health care includes a wide range of health and social services delivered in the home to treat illness or injury. Services covered by Medicare’s home health benefit include intermittent skilled nursing care, skilled therapy services, and care provided by a home health aide.

Medicare will cover home health care if:

1. You are homebound, meaning you need help leaving the house and doing so requires a lot of effort.
   1. Medicare considers you homebound if you need the help of another person or medical equipment such as crutches, a walker, or a wheelchair to leave your home, or your doctor believes that your health or illness could get worse if you leave your home. Additionally, leaving the home must require a lot of effort, and you typically cannot do so.
   2. Even if you are homebound, you can still leave your home for medical treatment, religion services, and/or to attend a licensed or accredited adult day care center without putting your homebound status at risk. Leaving home for short periods for time or special non-medical events, such as a family reunion, funeral, or graduation, should also not affect your homebound status. You may also take occasional trips to the barber or beauty parlor.
2. You need skilled nursing services and/or skilled therapy care on an intermittent basis.
   1. 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.
   2. Medicare defines skilled care as care that must be performed by a skilled professional, or under their supervision.
   3. Skilled therapy services refer to physical, speech, and occupational therapy. Note that 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.
3. You have a face-to-face meeting with a doctor within the 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 telemedicine visit.
4. 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 (see number 7) and that the face-to-face requirement was met.
   1. Your doctor should review and certify your home health plan every 60 days. A face-to-face meeting is not required for recertification.
5. And, you receive care from a Medicare-certified home health agency (HHA).

If you meet all the requirements, Medicare should pay for skilled care in your home and/or home health aide services. If you have questions or experience billing issues, speak with someone at the home health agency or call 1-800-MEDICARE.

-Marci