How to Qualify For Home Health Care Under Medicare

Home health care can be an integral component of Medicare beneficiary health. It can prevent coronavirus infection from spreading further and free up hospital beds for critical patients; and can even be less expensive than hospital stays. But for you to reap its benefits under medicare, first you must qualify. In this article we outline how you can qualify and what services are covered by home health care under Medicare.

To qualify for home health care under Medicare, you must meet certain requirements:

Your health condition makes leaving home difficult or harmful; this could be caused by an injury, illness or surgery; permanent chronic disease; or significant effort needed to leave without assistance from others such as wheelchair, cane or walker users; you must live in an area safe for self-reliance; your physician must certify your homebound status before any decisions can be made regarding that status.

Your doctor must certify that you require part-time or intermittent skilled nursing care, physical therapy, speech-language pathology services or occupational therapy. Medicare covers these as well as medical social services, durable medical equipment (like walkers) and supplies ordered by either you doctor or an agency certified to accept Medicare orders.

Medicare Part A will cover your first 100 days of home health care following hospital or skilled nursing facility (SNF) stays. Medicare Part B then covers any remaining home healthcare costs.

Before beginning home health care services, your doctor must create a plan of care which the home health team will adhere to and periodically revisit. This should include an estimate for how often services will be needed and reviewed at least every 60 days by your physician. Your doctor must recertify that home health care remains necessary before it can continue. If the provider determines otherwise, a written notice known as an Advance Beneficiary Notice of Noncoverage (ABN) should be issued to inform you. Instructions should also include how you can appeal the decision if necessary and any items not covered by your home health care agency so you can budget appropriately. As soon as your physician orders home health care, AARP recommends seeking a pre-claim review to avoid unexpected surprises and possible denials of service. Most home health agencies provide this service. If you have questions, reach out to either your Medicare-certified home health agency or call the helpline number: 1-800-MEDICARE; otherwise use the Medicare Cost Calculator available through AARP to give an estimated estimate of costs related to home care care.

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