A stroke often requires recovery and rehabilitation, and receiving care at home is an important part of this process for many patients. Home health care (HHC) is a range of medical services and assistance delivered in a patient’s residence for an illness or injury. This care provides a personalized and often less expensive alternative to a prolonged hospital or facility stay. Medicare covers home health care for stroke patients, but coverage is strictly conditional. The patient must meet specific eligibility rules, and the services must be considered medically necessary and focused on short-term, skilled rehabilitation.
Essential Eligibility Criteria
To qualify for Medicare’s home health care benefit, a stroke patient must satisfy several requirements. A doctor must certify the need for HHC, confirming the patient requires intermittent skilled nursing care or skilled therapy services. Skilled services include physical therapy, speech-language pathology, or occupational therapy needed to treat the stroke-related condition. The doctor must also establish and periodically review a plan of care, and a Medicare-certified home health agency must provide the services.
The patient must also be considered “homebound.” This does not mean being completely bedridden, but that leaving the home requires a considerable and taxing effort. A patient is homebound if they need assistive devices, special transportation, or another person to leave the house due to their illness or injury. Absences are permitted for medical treatment or for short, infrequent non-medical reasons, such as attending religious services.
Services Included in Home Health Care
Once a stroke patient is eligible, Medicare covers a specific set of medically necessary services aimed at recovery. Skilled nursing care is covered on an intermittent or part-time basis. This professional medical care may include wound care, managing injectable medications, or providing patient and caregiver education.
Medicare covers three forms of rehabilitation therapy: physical therapy (PT), occupational therapy (OT), and speech-language pathology (SLP). PT focuses on regaining strength, balance, and mobility lost after the stroke. OT helps patients adapt to perform daily living activities like bathing and dressing. SLP is crucial for patients experiencing difficulty with communication or swallowing. The services of a home health aide are also covered, but only if the patient is simultaneously receiving one of the skilled services. This aide provides personal care assistance, such as help with walking or grooming.
Important Coverage Limitations
The Medicare home health benefit is designed for short-term, restorative care and has distinct boundaries regarding what it will not cover. A significant limitation is the prohibition against covering 24-hour-a-day care in the home, which is often needed for patients with severe stroke-related deficits. Skilled nursing care is limited to “intermittent” care, meaning it is provided fewer than seven days a week or for less than eight hours per day for a short duration.
Medicare distinguishes between covered “skilled care” and non-covered “custodial care.” Custodial care involves non-medical tasks like meal preparation, shopping, or cleaning, and assistance with daily activities when that is the only care needed. If a patient only requires help with bathing and dressing, and not a skilled service like physical therapy, the custodial care is not covered. The benefit is intended to help the patient improve or maintain their condition, not to provide long-term maintenance care indefinitely.
Patient Costs and Financial Responsibility
For all home health care services covered by Medicare, the patient pays nothing. There is no deductible or coinsurance required for medically necessary skilled nursing care and therapy services. This includes the intermittent visits from nurses, therapists, and home health aides when the eligibility criteria are met.
The cost structure changes for durable medical equipment (DME), which is necessary for stroke recovery. DME includes items such as wheelchairs, walkers, and hospital beds. For these items, the patient is responsible for 20% of the Medicare-approved amount after meeting the Part B deductible. Although the services are covered at 100%, the associated equipment needed for mobility and safety results in some out-of-pocket expense.