CENTERS FOR MEDICARE & MEDICAID SERVICES CMS Product No. 11357

Revised September 2011

www.medicare.gov/HHCompare

Medicare’s Home 

Health Benefit

G E T T I N G S T A R T E D

Get Better in the 

Comfort of Your 

Own Home

If Medicare doesn’t pay for a service or supply, the 

home health agency will give you a Home Health 

Advance Beneficiary Notice to sign. This notice says 

Medicare probably (or certainly) won’t pay for the item 

or service. Read this notice carefully - if you sign it, 

you‘re agreeing to pay the entire cost if Medicare 

doesn’t cover the item or service. Your home health 

agency will also give you a notice called the Notice 

of Medicare Provider Non-Coverage before your 

Medicare-covered services end. If you think your 

Medicare-covered home health services are ending 

too soon, you may have the right to a fast appeal 

(also called an “expedited review”). Your Notice of 

Medicare Provider Non-Coverage gives instructions 

on how to ask for a fast appeal. Ask your doctor for 

any information that may help your case. If you ask for 

this fast appeal, an independent reviewer will decide 

if your services should continue. You have the right to 

participate in decisions about your treatment, the right 

to a fair process to appeal decisions about coverage and 

payment of services, and the right to privacy.

For more information, read the free booklets 

“Medicare Rights and Protections” and “Medicare 

Appeals,” visit www.medicare.gov, or call 

1-800-MEDICARE (1-800-633-4227). TTY users 

should call 1-877-486-2048.

KNOW YOUR RIGHTS WHERE CAN I GET MORE INFORMATION?

You can view or print Medicare publications and find helpful 

phone numbers and Web sites by visiting www.medicare.gov or 

calling 1-800-MEDICARE (1-800-633-4227). TTY users should 

call 1-877-486-2048. 

•	 To compare how well home health agencies in your area

care for patients (their quality) visit 

www.medicare.gov/hhcompare.

•	 To learn more about eligibility, coverage, and cost

information, read the free booklet “Medicare and Home 

Health Care.”

•	 To get a report on a particular home health agency, call 

your State Survey Agency. 

•	 For help with home health care bills, call your Regional 

Home Health Intermediary (RHHI).

•	 For free health insurance counseling and personalized help, 

call your State Health Insurance Assistance Program (SHIP).

•	 To learn more about your right to appeal coverage

and payment decisions, read the free booklet “Medicare 

Appeals.”
w w w . m e d i c a r e . g o v

YO U R D O C TO R S AYS YO U 

NEED HOME HEALTH C ARE

LET’S GET STARTED.

1 - 8 0 0 - M E D I C A R E

Home health care provides skilled nursing care, 

physical and occupational therapy, speechlanguage therapy services, and medical social 

services delivered in the comfort of your home. 

Home health care is ordered by your doctor, and 

if you’re leaving a facility like a hospital or skilled 

nursing facility, the discharge planner may help 

transition your care from the facility to home health 

care. Health care professionals from a Medicarecertified home health agency work with you and 

your doctor to evaluate your health care needs and 

write your plan of care, which tells you what home 

care services you need. The home health agency 

staff will teach you and your caregiver(s) (family or 

friends who are helping you) to continue any care 

you may need in the future, including wound care, 

therapy, and disease management. The goal is to 

help you reach and keep your best physical, mental, 

and social well-being. Although you have a say in 

which agency you use, your choices may be limited 

by the services the agency provides, your insurance 

coverage, or whether the agency is available.

WHAT’S COVERED

For Medicare to cover home health services, they must be 

reasonable and necessary for the treatment of an illness or injury.

A Medicare-certified home health agency may provide the 

following: 

•	 Skilled nursing care on a part-time or intermittent basis by a 

registered nurse or a licensed practical nurse

•	 Physical therapy, speech-language pathology services, and 

occupational therapy

•	 Home health aide services (like help with personal care 

such as bathing, using the toilet, or dressing) on a part-time 

or intermittent basis and medical social services (such as 

counseling or help finding resources in your community) if 

you’re also getting skilled care such as nursing care or other 

therapy from the home health agency

•	 Certain medical supplies, like wound dressings, that are ordered 

as part of your care

•	 Durable medical equipment (like a walker)

CAN I GE T COVERED HOME HEALTH 

C ARE? 

You can get covered home health care if you meet these conditions:

•	 Confined to the home

•	 Under the care of a doctor

•	 Getting services under a plan of care established and 

periodically reviewed by a doctor

CAN I GE T COVERED HOME HEALTH 

CARE? (CONTINUED) 

•	 In need of skilled nursing care on an intermittent basis or 

physical therapy or speech-language therapy, or in need of 

continuous occupational therapy

A doctor must certify your eligibility. Talk to your doctor to 

find out if you qualify.

WHAT DO I PAY?

You pay $0 for Medicare-approved home health services. 

For durable medical equipment (like a walker, wheelchair, or 

oxygen equipment), you pay 20% of the Medicare-approved 

amount, after you pay the Part B deductible.

P R OT E C T YO U R S E L F A N D M E D I C A R E 

FROM FRAUD

In general, most home health agencies are honest and use 

correct billing information. Unfortunately, fraud sometimes 

occurs. Examples of fraud include home health visits that 

your doctor orders that you didn’t get or bills for services and 

equipment you never got. Help us prevent fraud, waste, and 

abuse in the Medicare Program by reporting Medicare fraud to 

1-800-MEDICARE (1-800-633-4227). TTY users should call 

1-800-486-2048.

“Medicare’s Home Health Benefit: Getting Started” isn’t a legal 

document. More details are available in the “Medicare and Home 

Health Care” booklet. Official Medicare Program legal guidance is 

contained in the relevant statutes, regulations, and rulings.