Medicare will pay for home health care based on specific eligibility and duration criteria. Home health agencies that are licensed and certified home health services (LHHS) are able to bill Medicare for any Medicare-approved services such as skilled nursing or hospice services.
REASONS TO USE HOME HEALTH CARE: The following are situation where home health care is needed:
- Persons discharged from hospital and who are not fully recovered.
- Persons with chronic conditions who require frequent monitoring and can no longer meet their needs alone.
- Persons with a terminal disease who need skilled and/or personal care and pain management.
- Persons with limited mobility who need help with the Activities of Daily Living.
MEDICARE COVERED HOME HEALTH CARE SERVICES: Medicare Part A (or Part B if you do not have Part A) covers home health care services for as long as they are medically reasonable and necessary, but only if you meet all of the following conditions:
- You must be homebound or unable to leave home unassisted. Homebound means leaving home takes considerable and taxing effort. A person may leave home for medical treatment or short, infrequent absences for non-medical reasons.
- You must be receiving services under a plan of care established and periodically reviewed by a physician.
- You must need at least one of the following:
a. Intermittent skilled-nursing care (fewer than seven days a week or less than eight hours a
day over a period of 21 days), physical or speech-language therapy or continued occupational
therapy.
- The agency must be Medicare certified.
SERVICES NOT COVERED BY MEDICARE:
- 24-hour a day care at home.
- Meals delivered to your home.
- Homemaker services like shopping, cleaning and laundry.
- Errand services.
- Home health aide personal assistance services like bathing, dressing and toileting if this is the only care you need.
- Custodial personal care services.
