Medicare Coverage for In-Home Health Services

By the Greater Wisconsin Agency on Aging Resources Legal Services Team

Medicare covers part-time home health care when it’s medically necessary, ordered by a doctor, and provided by a Medicare-certified home health agency. Skilled services such as skilled nursing care or physical therapy are covered but custodial care that helps with daily living activities is not covered if it is the only type of care you need. You also need to be considered “homebound,” which means that leaving your home is difficult or not recommended because of your medical condition(s). These requirements are explained further below. 

Skilled Services

Skilled care is nursing or therapy care that can only be safely and effectively performed by, or under the supervision of, professionals such as nurses or licensed therapists. Examples of skilled services include:

• Skilled nursing care such as wound care, intravenous medications, feeding tube care, injections, or monitoring of a serious illness or condition

• Physical therapy, occupational therapy, and speech-language pathology services

• Part-time or intermittent home health aide care such as help with bathing, grooming, and feeding but only if you’re also getting skilled nursing care, physical therapy, speech-language pathology services, or occupational therapy. Otherwise, Medicare does not cover these types of services when it’s the only type of care you need. 

These services must be needed on an intermittent basis or part-time. This means less than 8 hours each day and 28 hours or less each week. There is no maximum number of days covered, but payment and care needs are assessed every 30 days. 

Homebound 

If you’re homebound it means that you have trouble leaving your home without help or it requires a significant effort. It could also be that you’re normally able to leave your home, but it isn’t recommended due to your current illness or injury. This does not mean that you can never leave home like to go to church or a doctor appointment, just that it is very difficult for you to do so. Your doctor will document this when they order the care.

Finally, you must make sure the home health agency is Medicare-certified. To find a home health agency, you can visit the Wisconsin Department of Health Services website at https://www.dhs.wisconsin.gov/guide/home-health.htm, and for more information on Medicare coverage of home health services, visit https://www.medicare.gov/coverage/home-health-services.