Medicare can pay for nursing and therapy in your home, but the rules come with their own vocabulary. Words like “homebound,” “plan of care” and “recertification” show up on forms and in phone calls, often when you are already worn out from an illness or hospital stay. This guide to understanding your Medicare home health benefits in Tampa explains the key terms in plain language, how Original Medicare and Medicare Advantage differ, what is not covered, what notices you may receive, and what to ask so you are never caught off guard.
For a short summary of who qualifies and what Medicare covers, see our Medicare home health care page. This article goes deeper into how the benefit works day to day.
Key terms in your Medicare home health benefit
Home health care
Home health care is medical care in your home ordered by a doctor or allowed practitioner. It includes skilled nursing, physical therapy, occupational therapy, speech-language therapy, medical social work and home health aide visits. It is not the same as home care, which usually means help with housework, errands or company, often paid privately.
Skilled care
Skilled care is care that has to be done by, or under the supervision of, a nurse or therapist to be safe and effective. Examples include wound care, teaching about a new medicine, checking a heart failure patient’s weight and symptoms, or gait training after surgery. Skilled care can also be needed to keep your condition from getting worse, not just to help you improve.
Part-time or intermittent
Medicare home health is made up of scheduled visits, not someone in your home all day. A nurse or therapist may come a few times a week for a set time, depending on your needs.
Homebound
You are homebound when leaving home takes considerable and taxing effort because of your illness or injury. You may need a cane, walker, wheelchair, special transportation or another person’s help to get out, or your doctor may advise you not to leave. Homebound does not mean you never leave. Short, infrequent outings for medical care, religious services or adult day care are OK.
Face-to-face visit
Before Medicare pays for home health care, a doctor or allowed practitioner must see you about the main reason you need care. That visit must happen within 90 days before or 30 days after care starts. A visit in the hospital or a skilled nursing facility can count.
Certification and the plan of care
Your doctor or allowed practitioner certifies that you meet the rules and signs your plan of care. The plan of care lists which services you get, how often, your goals, your medicines and any equipment or supplies. Your home health team follows it and asks your doctor for new orders when your needs change.
Recertification
Home health care is approved in periods of up to 60 days. Near the end of each period, your team and your doctor review your progress. If you still qualify and need skilled care, your doctor can recertify you for another period. If you have met your goals, the team plans your discharge with you.
Medicare-certified agency
Medicare only pays agencies that are certified, meaning they meet federal home health rules and are inspected to confirm it.
Who qualifies for Medicare home health benefits?
In short, you qualify when a doctor or allowed practitioner (a doctor, nurse practitioner, clinical nurse specialist or physician assistant) certifies that:
- You need part-time or intermittent skilled nursing, physical therapy or speech-language therapy, or continued occupational therapy
- You are homebound
- You had a face-to-face visit within 90 days before or 30 days after care starts
- A plan of care is set up and reviewed regularly by your doctor or allowed practitioner
You also need to use a Medicare-certified agency. You do not need a hospital stay first. Our Medicare home health page walks through each rule in more detail.
Original Medicare vs. Medicare Advantage
How your benefit works in practice depends a lot on which kind of Medicare you have. If you show your red, white and blue Medicare card at the doctor’s office, you most likely have Original Medicare. If you show a card from a private insurance company with “Medicare” in the plan name, you most likely have a Medicare Advantage plan.
Original Medicare
- You can choose any Medicare-certified agency that serves your address and accepts you.
- Medicare pays the agency directly for covered home health services.
- Medical equipment, such as a walker or hospital bed, is covered under a separate equipment benefit with its own cost-sharing.
Medicare Advantage
Medicare Advantage plans are run by private insurance companies approved by Medicare. They must cover home health care, but each plan sets its own rules:
- Networks. You usually need to use an agency in the plan’s network. Going outside the network may cost more or may not be covered.
- Prior authorization. The plan may need to approve home health care before it starts, and again before more visits are added.
- Cost-sharing. Each plan has its own rules about what you pay.
The member services number on the back of your card is the best place to check your plan’s rules. We accept Traditional Medicare, plus long-term care plans and private pay. Medicare Advantage coverage and our participation depend on your specific plan, so we verify both before care starts. Call (813) 931-0015 to verify your coverage. The current list is always on our insurance page.
What Medicare home health does not cover
Knowing the limits early helps your family plan. Medicare home health does not cover:
- Care around the clock, 24 hours a day, at home
- Meal delivery
- Homemaker services, such as shopping, cleaning and laundry
- Personal care, such as bathing or dressing, when that is the only care you need
Home health aide visits for bathing and personal care can be covered, but only while you are also getting skilled care.
Prescription medicines are usually covered by your Part D plan or your Medicare Advantage plan’s drug coverage, not by the home health benefit. If your loved one needs more help than part-time visits can give, our guide comparing home health care and assisted living can help you weigh other options.
Notices you may receive, and your right to appeal
Medicare gives you rights, and some of them come in writing. You do not need to memorize the names of the forms. What matters is that you read them, ask questions and know you can speak up.
- Before a service Medicare may not pay for. If your agency believes Medicare may not cover a service or supply, it must tell you in writing before giving it. The notice explains your choices, including whether you want the service anyway.
- Before covered care ends. When all your covered home health services are ending, your agency must give you a written notice ahead of time. It explains how to ask for a fast appeal by an independent reviewer if you think your care is ending too soon.
- Medicare Advantage decisions. If your plan denies or limits home health care, it must tell you in writing and explain how to appeal to the plan.
- After care. People with Original Medicare get a Medicare Summary Notice that lists services billed. Check it and call about anything that looks wrong.
Keep every notice in a folder, write down the date you got it, and act quickly, because appeals have deadlines. If something is unclear, call your agency, your plan or 1-800-MEDICARE.
Questions to ask about your benefits
Ask your doctor:
- Do I qualify for home health care, and which services will you order?
- Has my face-to-face visit been done and written up?
- Will you be the one signing my plan of care?
Ask your plan (if you have Medicare Advantage):
- Which home health agencies are in my network?
- Does home health care need prior authorization?
- What will I pay for home health visits and equipment?
Ask the agency:
- Do you serve my address, and do you accept my coverage?
- Will you verify my benefits and explain any costs before care starts?
- Which services and how many visits does my plan of care include?
- What happens when my certification period ends?
- Who do I call with questions between visits?
Tips for families managing the benefit
- Keep one folder with the Medicare card, plan card, medicine list, doctors’ names and any notices.
- If you can, have a family member join the first home health visit.
- Write down the name of your main contact at the agency.
- Tell the agency right away if your doctor, insurance or address changes.
When you are ready to begin, our step-by-step guide on how to start home health care explains what happens next.
How Making Memories Home Health can help
Making Memories Home Health is a Medicare-certified, Joint Commission-accredited home health agency based in Tampa, serving Hillsborough, Polk and Manatee counties. Our intake team checks your Medicare or plan benefits, requests approval from your plan when it is needed, and explains any costs before care starts. We can explain everything in English or Spanish.
Have a question about your Medicare home health benefits? Call us at (813) 931-0015. Doctors and case managers can send a referral online.
Frequently asked questions
Does Medicare limit how many home health visits I can get?
There is no set number of visits. Coverage continues as long as you still qualify and your doctor reviews and renews your plan of care. Your care ends when you meet your goals or no longer need skilled care at home.
Do I have to be getting better for Medicare to keep covering home health?
No. Medicare can cover skilled nursing or therapy that helps keep your condition from getting worse, as long as you need the skills of a nurse or therapist and meet the other rules. Coverage is based on your need for skilled care, not only on improvement.
Can I get home health care if I have a Medicare Advantage plan?
Yes. Medicare Advantage plans must cover home health care, but each plan sets its own rules. You usually need an agency in the plan's network, and the plan may need to approve care before it starts. Call the member services number on your card, or ask the agency to check for you.
Where can I get unbiased help with Medicare questions in Florida?
You can call 1-800-MEDICARE (1-800-633-4227) any time. Florida's SHINE program, run by the Florida Department of Elder Affairs, offers one-on-one counseling on Medicare questions from trained volunteers. Your home health agency can also explain how your own coverage applies to your care.