Understanding Home Health Care and Medicare

Home health care is a good alternative to care in a hospital or skilled nursing facility, as it's usually less expensive and more comfortable and convenient for patients, according to Medicare.gov. Medicare rules and regulations can be difficult to understand, however. If you're in need of a home health nurse, you'll want to make sure the services you require are covered. 


Medicare requires you to meet several requirements to be eligible for home health care benefits.

  1. You must be regularly seeing a doctor who has a plan of care established for you.
  2. Your doctor must agree that you need physical therapy, speech therapy, occupational therapy, and/or intermittent skilled nursing care. "Intermittent" is important here—if you require more than intermittent skilled nursing care, you won't be eligible for the Medicare home health benefit, though you may be eligible for care in a skilled nursing facility outside your home. Intermittent care is care that's given fewer than 7 days a week or less than 8 hours each day over a 21-day period, according to Medicare rules. "Skilled nursing" means that your care is administered by a registered nurse (RN) or a licensed practical nurse (LPN).
  3. Your home health care must be from an agency that is certified by Medicare.
  4. Your doctor must certify that you're homebound.

What Does "Homebound" Mean?

According to Medicare rules, "homebound" doesn't mean you can literally never leave your house. You can leave for doctor's appointments or to get medical care outside your home. You can attend an adult day care program and still be considered homebound, and you can leave your home for short times for nonmedical reasons, like going to church or attending short family gatherings.

For your doctor to classify you as homebound he or she must certify that

  • your doctor doesn't recommend that you leave your home due to your medical condition.
  • your medical condition prevents you from leaving your home without help—either from a medical device, such as a wheelchair or walker, or from an able-bodied person.
  • leaving your home requires considerable effort.

What Services Are Not Covered by Medicare?

There are certain in-home services Medicare won't pay for under your home health care benefit. These services include

  • 24-hour in-home care
  • delivered meals
  • personal care, like help with bathing and dressing, if this is the only care you're receiving.
  • household services, such as laundry and cleaning, if this is the only care you're receiving and these services are not related to your plan of care. Your plan of care is a plan that details what kinds of services you should receive. Your doctor and your home health agency will work together to draft this plan, and you have the right to be involved in the decisions made about your care.

If you're currently searching for a home health nurse, find one at an establishment like First In Care Home Health Agency Inc.

About Me

home health care for children and adults

Having a special needs child introduces so many complications into the life of a family. The minute my niece was diagnosed with a very rare liver disorder, our entire family came together to try to help with her care. Unfortunately, even with so many people pulling together to help my sister through the day, she was still being run ragged. That is when the home health care worker came into play. If you are considering a home health care worker, this blog could help you learn about the services that are provided for both children and adults requiring a great deal of medical attention at home.