Does Medicare Cover Home Health Care for Rehabilitation Services?

Yes, Medicare covers home health care for some rehabilitation services. Common support includes physical, speech and occupational therapies. Some individuals also benefit from nutrition therapy as part of their care plans. Coverage and rules differ depending on the precise services required, and physicians must certify ongoing needs.

Individuals must meet general Medicare eligibility measures before applying for home health care coverage. People qualify for Medicare if they or their spouse have paid enough payroll taxes and have reached age 65. Alternatively, they may be eligible if they receive Social Security Disability Insurance for a long-term disability, have end-stage kidney failure or have ALS.

Further requirements apply for home health care coverage. A physician must prescribe services and certify that an individual meets homebound criteria and has a medical need for care at home. Additionally, Medicare-certified agencies must provide home health care.

When an individual qualifies for home health care, they receive covered services in line with their physician’s recommendations. Home health care packages include physiotherapy and speech-language pathology (including cognitive speech therapy) as primary needs, meaning an individual may only require these services. However, providers may only include occupational therapy alongside medically necessary skilled nursing care or other therapies. 

Home health care plans can’t start based on occupational therapy alone. But when recertification occurs every 60 days, occupational therapy may continue if that remains the only necessary support. For example, if a doctor’s initial order included aspects of skilled nursing, physical therapy and occupational therapy, and the individual no longer needs the first two services, the physician can recertify and prescribe home health care based on just occupational therapy. Likewise, nutrition therapy can stand as part of a wider rehabilitation package but not as a stand-alone home health service. 

The World Health Organization defines rehabilitation as a “set of interventions designed to optimize functioning and reduce disability in individuals with health conditions in interaction with their environment.” It includes diverse measures that promote independence and safety in everyday life by finding ways to overcome challenges created by disabilities or health conditions. Medicare home health care doesn’t include every type of rehabilitation therapy. For example, it doesn’t cover:

• Cardiac rehabilitation: Although covered by general Medicare, therapy must occur in an outpatient setting outside of the home.
• Psychiatric rehabilitation: But insurance covers other inpatient and outpatient mental health services.

Pulmonary rehabilitation: Services fall outside home health care, and Medicare covers pulmonary therapies provided in clinics or hospitals.