What is home health? What does Medicare pay for?

HomeHealth Questions

According to the www.medicare.gov website, home health care provides skilled, short-term services in-home. These services are typically ordered by a doctor to help with recovery following an inpatient hospital stay, rehabilitation, or a stay at a facility providing skilled nursing care. In general, the goal of home health care is to help you get better, regain your independence, and be as self-sufficient as you can.

Who’s eligible? All people with Part A and/or Part B Medicare who meet all of these conditions are covered:

  • You must be under the care of a doctor, and you must be getting services under a plan of care created and reviewed regularly by a doctor.
  • You must need, and a doctor must certify that you need, one or more of these:
    • Intermittent skilled nursing care (other than drawing blood)
    • Physical therapy, speech-language pathology, or continued occupational therapy services. These services are covered only when the services are specific, safe and an effective treatment for your condition. The amount, frequency and time period of the services needs to be reasonable, and they need to be complex or only qualified therapists can do them safely and effectively. To be eligible, either: 1) your condition must be expected to improve in a reasonable and generally predictable period of time, or 2) you need a skilled therapist to safely and effectively make a maintenance program for your condition, or 3) you need a skilled therapist to safely and effectively do maintenance therapy for your condition. The home health agency caring for you is approved by Medicare (Medicare certified).
  • You must be homebound, and a doctor must certify that you’re homebound

You’re not eligible for the home health benefit if you need more than part-time or “intermittent” skilled nursing care. You may leave home for medical treatment or short, infrequent absences for non-medical reasons, like attending religious services. You can still get home health care if you attend adult day care.

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
  • Custodial or personal care (like bathing, dressing, or using the bathroom), when this is the only care you need

An in-depth explanation of home health is provided in Medicare’s Official Booklet and can be found here.

If you have additional questions about home care in the DFW area, please call us at 972-471-1111.

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