How Can One Qualify for Home Health Care Under Medicare?

One can qualify for home health care under Medicare by meeting the eligibility criteria to determine a genuine need for medical assistance. These criteria include being homebound, being under the care of a doctor and needing skilled nursing or therapy services.

Home health care benefits under Medicare aim to provide medical services and support for individuals who prefer to receive care in their homes rather than in a medical facility or institutional setting. Medicare comprises different parts that cover the following services:

 

• Medicare Part A: Hospital insurance covering hospital stays, institutional skilled nursing services, hospice care and some home health care
• Medicare Part B: Medical insurance covering doctors' services, outpatient care, medical supplies and preventive services
• Medicare Part D: Prescription drug coverage funding the cost of medications, typically for a premium

Home health care benefits fall under the coverage of Parts A and B. Services typically include:

 

• Intermittent skilled nursing
• Hospice care
• Physical therapy
• Speech-language pathology
• Medical social services
• Continued occupational therapy
• Preventative services
• Durable medical equipment
• Mental health services
• Some outpatient drugs

To qualify for home health care benefits under Medicare, you must be 65 or older, receive Social Security benefits and satisfy the following conditions:

 

• Doctor's Care: You must be under the care of a doctor and receiving services consistent with a plan of care established and reviewed regularly by that doctor.
• Certification of Need: A doctor must certify that you require one or more of the following services:
  • Intermittent skilled nursing care
  • Physical therapy
  • Speech-language pathology
  • Continued occupational therapy
• Homebound Status: You must be homebound, meaning that leaving your home proves extremely difficult or requires considerable and taxing effort.
• Medicare-Approved Agency: You must contract a Medicare-certified home health care agency to provide the necessary services.

 

Talk to your doctor and complete any necessary assessments. They will refer you to a certified home health care agency in your area that can schedule a visit and consultation to determine the services you need.

Understanding the limitations of Medicare coverage for home health care services remains crucial. Nonmedical care and services at home do not fall under Medicare coverage, including homemaker services and personal care, meal deliveries, chore services and assistance with activities of daily living. Coverage may extend to these services if they occur alongside other medically necessary care.

After a qualifying hospital stay, Medicare pays 100% of the costs for approved home health care services. However, Medicare may require you to pay 20% of the cost of durable medical equipment, such as wheelchairs, walkers and hospital beds. If you require more coverage than is available through Original Medicare, consider a Medicare Supplement Insurance, or Medigap, policy.