As a Home Health Care Agency in Milwaukee, we get a lot of calls from people who have Medicare and are in need of home health care. They assume that Medicare will pay for whatever services they need. This is not the case. In order for Medicare to pay for home health services, there are certain criteria that need to be met and not all services are covered. In this article we explain the criteria, and what services are covered. In addition, at the end of the article we have a link to a page on our website that explains what other types of insurance will typically cover home health care services.
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
See our SERVICES page for more detail on these services.
- The home health agency caring for you must be approved by Medicare (Medicare-certified). PHCS is 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 (such as using a wheelchair or walker, needing special transportation, or getting help from another person).
- Leaving home takes a considerable and taxing effort.
A person may leave home for medical treatment or short, infrequent absences for non-medical reasons, such as attending religious services. You can still get home health care if you attend adult day care, but you would get the home care services in your home.
Medicare Eligibility is also based on the amount of services you need
If you meet the conditions above, Medicare pays for your covered home health services for as long as you’re eligible and your doctor certifies you need them. If you need more than part-time or “intermittent” skilled nursing care, you aren’t eligible for the home health benefit.
To decide whether you’re eligible for home health care, Medicare defines part-time or “intermittent” as skilled nursing care that’s needed or given on fewer than 7 days each week or less than 8 hours each day over a period of 21 days (or less).
Medicare does Not pay for:
- 24-hour-a-day care at home.
- Meals delivered to your home.
- Homemaker services like shopping, cleaning, and laundry when this is the only care you need, and when these services aren’t related to your plan of care.
- Personal Care Services given by home health aides like bathing, dressing, and using the bathroom when this is the only care you need. To find out more about Personal Care Services please click here.
This is a link to more information about Medicare and Home Health Care: http://www.medicare.gov/pubs/pdf/10969.pdf
For more information about other type of insurance that may cover the home health care services you need, please CLICK HERE.
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