How does someone qualify for Medicare coverage of at-home care?

Page 6 of Medicare Coverage for Home Care and Skilled Nursing Care

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For Medicare Part A or Part B to cover a patient's at-home care, several conditions have to be met:

  • Need for part-time skilled care: The patient must have a medical need for, and his or her doctor must prescribe, skilled nursing care or rehabilitative physical or speech therapy. The care must be needed part-time only, to help recover from a specific illness, injury, or acute condition. If, instead, the patient needs care because of a long-term condition or general frailty, Medicare will not cover it. Nor will Medicare cover full-time or daily care.
  • Confinement to home: Medicare covers at-home care only if and for as long as the patient is "confined to home." This means that he or she is unable to leave home without difficulty and with the assistance of another person or a medical device such as a wheelchair. However, it doesn't necessarily mean bedridden.
  • Recovery period: At-home care is covered only while the patient is actively recovering, which means while his or her condition is improving. Once a patient's condition has stabilized, as determined by his or her physician, the home care agency, and Medicare, coverage ends.
  • Medicare-approved agency: Medicare only covers home care provided by a Medicare-certified home healthcare agency. Unfortunately, this leaves out registry nurses, private therapists, and independent caregivers.

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