Medicare and Home Health Care: Eligibility
If you have Medicare, you can use your home health benefits if you meet all the following conditions:
- You must be under the care of a doctor, and you must be getting services under a plan of care established and reviewed regularly by a doctor.
- You must need, and a doctor must certify that you need, one or more of the following.
- Intermittent skilled nursing care
- Physical therapy
- Speech-language pathology services
Continued occupational therapy
- The home health agency caring for you must be approved by Medicare (Medicare-certified).
- You must be homebound, and a doctor must certify that you’re homebound. To be homebound means the following:
- Leaving your home isn’t recommended because of your condition.
- Your condition keeps you from leaving home without help
- Leaving home takes a considerable and taxing effort.
Medicare and Home Health Care: How Medicare pays for home health care
In Original Medicare, Medicare pays your Medicare-certified home health agency one payment for covered services you get during a 60-day period. This 60-day period is called an “episode of care.” The payment is based on your condition and care needs.
Getting treatment from a home health agency that’s Medicare-certified can reduce your out-of-pocket costs. A Medicare-certified home health agency agrees to the following conditions:
- To be paid by Medicare
- To accept only the amount Medicare approves for their services
Medicare’s home health benefit only pays for services provided by the home health agency. Other medical services, such as visits to your doctor, are generally still covered by your other Medicare benefits.
Medicare and Home Health Care: What Medicare covers
If you’re eligible for Medicare-covered home health care Medicare covers the following services if they’re reasonable and necessary for the treatment of your illness or injury:
- Skilled nursing care. Skilled nursing services are covered when they’re given on a part-time or intermittent basis. In order for skilled nursing care to be covered by the Medicare home health benefit, your care must be necessary and ordered by your doctor for your specific condition. You must not need full time nursing care and you must be homebound. Skilled nursing services are given by either a registered nurse (RN) or a licensed practical nurse (LPN).
- Physical therapy, occupational therapy, and speech-language pathology services.
- Medical social services.
- Medical supplies.
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For help finding the best Medicare or Individual Health Plan for you, please contact Liberty Medicare or call us at 877-657-7477.