Care at Home: What Does Medicare Cover?

Medicare covers home health services under Part A and/or Part B. Medicare also covers medically necessary part-time or intermittent skilled nursing care. A doctor or healthcare provider must order your care, and a Medicare-certified home health agency must provide it. Your doctor, or other healthcare provider (such as a nurse practitioner), must assess you face-to-face before certifying that you need home health services such as:

• Skilled nursing services provided up to seven days per week for generally no more than eight hours per day and 28 hours per week.
• Skilled therapy services, such as physical, speech, and occupation therapy home health aides, as long as you require skilled care as well.
• Home health aide, as long as you require skilled care as well.
• Medical social services to help with social or emotional concerns related to your illness.
• Certain medical supplies, such as wound dressings and catheters.
• Certain durable medical equipment (DME), such as a wheelchair or walker.
• Note: Medicare should pay for these services regardless of whether your condition is temporary or chronic and regardless of whether your condition is improving or not.

You can recognize and prevent home healthcare fraud by remembering the following tips:

• Carefully read your Medicare Summary Notice (MSN) and/or Explanation of Benefits (EOB) to ensure they accurately reflect the services you received.
• Work with your doctor to enroll in home health services and determine your plan of care; do not enroll in home health services with a doctor you do not know.
• Do not accept gifts like money or groceries in return for home health services.

If you have any questions or suspect Medicare fraud or errors, please call your SHIP (state health insurance assistance program) coordinator, Lynn Hixon, at the DeKalb County Council on Aging at 256-845-8590.