General Home Health Care Information
Palmetto GBA Railroad Medicare (original Medicare) covers Part B services, such as doctors’ visits, surgeries, preventive services, lab tests and some ambulance transports or services furnished by other non-physician practitioners or suppliers.
Home health is a covered service under the Part A Medicare benefit. It consists of part-time, medically necessary skilled care (nursing, physical therapy, occupational therapy, and speech-language therapy) that is ordered by a physician.
In order to be eligible for Home Health Care, you must be 'homebound' and a doctor certifies that you are homebound. Being homebound means that:
- Leaving your home isn’t recommended due to your condition (you are confined to your home)
- You are unable to leave home without help (such as by using a wheelchair or walker, needing special transportation, or getting help from another person)
- Leaving home takes a considerable and difficult effort
Other requirements for Home Health Care:
- You are under the care of a physician
- You receive services under a plan of care that was created and is reviewed on a periodic basis by a physician
- You are in need of skilled nursing care on an intermittent basis, or you need physical therapy or speech-language pathology services; or you have a continuing need for occupational therapy after your need for skilled nursing, physical therapy or speech-language pathology has ended
- If your only need is for skilled oversight of unskilled services (a long way of saying the management and evaluation of the care plan established for you), then your doctor must include a statement that explains how Home Health Care is clinically and medically necessary for you
The doctor that creates the plan of care and certifies that you need Home Health Care must be enrolled with Medicare. They must also be a doctor of medicine, osteopathy or podiatric medicine. They have to certify that you are receiving Home Health Care under their care.
Your doctor must certify that you need Home Health Care when the plan of care is created, or very soon after that. The certification has to be signed and dated by the physician that created your plan of care, and this must be completed before a home health agency bills Medicare.
Home health services include skilled nursing care (on a part-time or intermittent basis). They must be medically necessary and ordered by your doctor and provided by a registered nurse (RN) or a licensed practical nurse (LPN).
Skilled nursing care can include giving IV drugs or shots, changing wound dressings, tube feedings, etc. Services that can be safely given by you yourself or by a non-medical person without nurse supervision are not considered skilled nursing care.
Other covered home health services include physical therapy, occupational therapy, and speech-language pathology services when deemed medically necessary as long as one of the following applies:
- Your doctor expects your condition will improve in a reasonable and fairly predictable period of time
- You need a skilled therapist to safely and effectively create a maintenance program or to perform maintenance therapy
As with all covered Medicare services, the number, frequency and duration of these services must be medically necessary and reasonable.
Home Health Care can also help pay for medical social services when they are ordered by your doctor to help you with social or emotional difficulties related to your illness. It also can assist with paying for medical supplies, such as wound dressings, when they are ordered as part of your care.
Home Health Care doesn’t cover everything. Some things which are excluded from this program include 24-hour day care at your home, meals delivered to your home, shopping/cleaning/laundry assistance and other non-skilled custodial care when these services are not related to your plan of care.
Once your doctor determines that you need Home Health Care, you will need to select an agency in your area that is certified by Medicare. Information on these agencies can be found using the 'Home Health Compare' web tool at www.medicare.gov/HHCompare.
View the CMS Medicare & Home Health Care booklet (PDF, 1.92 MB) for more information on the Medicare home health care benefit.
If you have questions about Home Health Care, please call 1-800-MEDICARE/800-633-4227 or 877-486-2048 for TTY. Another resource is your State Health Insurance Assistance Program (SHIP). Counselors at SHIP can also answer questions about Medicare’s Home Health Care.
For general questions about Railroad Medicare (Part B) coverage, please call our Beneficiary Contact Center at 800-833-4455 or for TTY, call 877-566-3572. Representatives are available Monday through Friday from 8:30 a.m. to 7 p.m. ET. We also invite you to visit our Facebook page called 'My RR Medicare' at www.facebook.com/myrrmedicare and our website at www.PalmettoGBA.com/rr/me.