Medicare home health care is a service Medicare provides to homebound patients who need intermittent skilled nursing care or therapy services. It includes skilled nursing care, physical therapy, speech-language pathology, occupational therapy, and home health aide services. To be eligible for Medicare home health care, patients must meet specific criteria, including seeing a physician or authorized health care provider, being homebound, and needing intermittent skilled nursing care or therapy services. The care must be provided by or under arrangements with a Medicare-certified provider.

Medicare can cover home health care if it meets the following criteria:

  1. The patient must see a physician or authorized health care provider. The physician/provider must write a brief narrative describing the patient’s clinical condition and how the patient’s condition supports homebound status and the need for skilled home health services.
  2. A physician/authorized provider has signed or will sign a plan of care.
  3. The patient is homebound. This standard is met if leaving home requires a considerable and taxing effort, which may be shown by the patient needing personal assistance, or the help of a wheelchair crutches, or other supportive device. Occasional but infrequent “walks around the block” and outings are allowable. Attending an adult day center or religious services is not an automatic bar to meeting the homebound requirement.
  4. The patient needs skilled nursing care intermittently (at least once every 60 days) or physical or speech-language pathology. (Occupational therapy can continue Medicare home health care but not begin coverage.)
  5. The care must be provided by or under arrangements with, a Medicare-certified provider.

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