How to Qualify For Home Health Care Under Medicare

how to qualify for home health care under medicare

Home health care may become necessary if you’re an older adult or have a chronic medical condition like diabetes. Home healthcare provides important relief after hospital stays as well as helping manage illnesses, injuries or chronic diseases such as diabetes.

Medicare Part B (Medical Insurance) covers at-home health services if you meet certain requirements. To qualify, your doctor or authorized practitioner must create and regularly review an individualized care plan for home health services that is determined to need intermittent skilled nursing care, physical therapy or speech-language therapy according to Centers for Medicare & Medicaid Services guidelines. Furthermore, their physician must certify that you’re homebound without significant effort or an assistive device such as wheelchair or walker for transportation outside of your home.

Medicare-certified home health agencies must be used, with 20% of Medicare’s approved amount for durable medical equipment such as hospital beds being paid by you at 20% of its approved amount, in addition to paying your standard Part B deductible. Some private Medicare Advantage plans (commonly known as Part C) offer home health benefits; these may have different rules and costs compared with original Medicare.

Home health services involve regular visits from a health care provider who will assess your progress and address any concerns, provide medical supplies such as wound dressings or catheters as needed and check blood pressure, temperature, heart rate and breathing rates as well as teaching you basic tasks such as taking baths and making meals.

Medicare-certified home health agencies also provide various rehabilitative therapies such as massage, occupational and physical therapy services; however, these typically only come as part of your home health care plan; Medicare does not pay for long-term custodial care.

If your needs for home health care change, your healthcare team will collaborate with you and your family to formulate a new plan of care which may involve additional visits or other forms of home health services. Feel free to reach out to your home health agency in order to discuss this change.

Your home health agency should provide an in-depth explanation of Medicare coverage and provide an Advance Beneficiary Notice of Noncoverage (ABN) should they believe any services or items won’t be covered. This document details all available options and costs so you can make an informed decision.

Medicare-certified home health agencies must share information with your physician to ensure you’re receiving optimal care. They should also keep in contact with and communicate regularly with your primary care physician (PCP).

If your home health agency believes that your care needs have altered and no longer necessitate home health services, they must notify you in writing of this change and outline how you can appeal their decision if this decision doesn’t satisfy you.

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