Does Medicare Cover Home Health Care for Occupational Therapy?

Yes, Medicare covers home health care for occupational therapy. No limits exist regarding how much therapy an individual receives as long as a doctor orders the care and deems it medically necessary. Federal insurance pays the full cost of occupational therapy delivered by home health care agencies.

Occupational therapy helps individuals develop, maintain or recover essential skills for day-to-day life. For older adults, occupational therapy aids recovery after an illness, injury or hospital procedure. It also benefits those experiencing frailty, cognitive decline and other conditions that lead to the loss of certain skills, for example:

• Bathing and brushing teeth
• Combing hair and shaving
• Fastening buttons, putting on shoes and getting dressed
• Using the toilet
• Transferring between the bed and a chair
• Moving from room to room

Therapists assess an individual’s skills and create a personalized plan with specific goals. Treatment plans may include adjusting how people do things to compensate for loss of abilities in certain areas. Professionals also train people to use assistive devices and may implement home adaptations. In addition to boosting their practical abilities, therapy can give seniors the confidence to live independently and manage their daily affairs.

Home health care plans include wide-ranging clinical and therapeutic services, including:

• Occupational therapy
• Physical therapy
• Speech therapy
• Skilled nursing
• Medical social services

Medicare covers intermittent home health care services through Parts A and B, including occupational therapy, for eligible seniors. A doctor must prescribe services and deem them medically necessary, and providers must have Medicare certification. Therapists and other medical professionals visit seniors in their homes to deliver services tailored to their needs.

Seniors who receive occupational therapy in an outpatient setting, such as at a clinic or nonresidential rehabilitation center, may qualify for partial Medicare funding under Part B only. Although no limits exist regarding the amount of coverage, Medicare only pays for 80% of the costs for therapy; seniors have a copay for the remaining amount.