How to Qualify for Home Health Care under Medicare

In general, to qualify for Medicare-covered home health services you’ll need intermittent skilled nursing and/or physical, occupational or speech therapy as well as being homebound (requiring considerable effort or aid from devices like wheelchairs or walkers to leave your house without considerable difficulty), as well as being on a doctor-issued plan of care that specifies which services and for how long. Finally, your services must come from an agency approved by Medicare.

As long as you are enrolled in either Original Medicare or a Medicare Advantage plan with home health coverage, typically these services won’t cost anything (after meeting your Part B deductible). Coinsurance amounts depend on your coverage type.

If you are a beneficiary of Medicare Advantage, review your plan documents to understand exactly how much home health care may cost you. In addition, work with an agency participating with Medicare so your care is tracked properly and benefits are applied as expected.

To ensure low premiums, ensure the home health agency you select is Medicare-approved and offers services from providers with high customer satisfaction ratings.

We have observed that people with Original Medicare are generally more likely to qualify and obtain home health services than those enrolled in Medicare Advantage plans, due partly to limited coverage provided by some plans for home healthcare services.

As an example, certain Medicare Advantage plans restrict the number of visits per week from home health therapists and do not always provide in-home therapies for various conditions. From our experience, people with Medicare Advantage tend to be less likely to be referred to home health services by their doctors; consequently it can be challenging for beneficiaries to qualify for care they require. It is recommended to discuss this with your physician in order to take the steps necessary to receive proper attention.