When is home health care covered by medicare?

Part A covers inpatient hospitalizations, skilled nursing facility care, hospice care, and some home health care. Learn more about home health care · Your Medicare coverage · Physical therapy If you get services from a home health agency in Florida, Illinois, Massachusetts, Michigan, or Texas, you may be affected by a Medicare demonstration program. Based on this demonstration, your home health agency, or you, can submit a request for pre-claim review of home health coverage to Medicare. This helps you and the home health agency know earlier in the process if Medicare is likely to cover services.

Medicare will review information and cover services if they are medically necessary and meet Medicare requirements. During the COVID-19 pandemic, nurse practitioners, clinical nurse specialists and physician assistants can now provide home health services, without a doctor's certification. The only way Medicare will cover your home health care costs is if you get your care from a Medicare-approved home health agency. Your doctor may give you recommendations for agencies that are approved by Medicare and you may trust your patients.

Medicare only pays for a personal home health care assistant when a person also receives skilled nursing care or rehabilitation services through home health care. Medicare doesn't cover personal home health aides as a standalone service. Medicare believes that being confined to your home means you can't leave your home without help, or that your health condition generally requires you to stay home. This notice allows both the agency and the Medicare beneficiary to confirm coverage and set expectations early in the process.

That period is renewable, which means Medicare will continue to provide coverage if your doctor re-certifies at least once every 60 days that in-home services are still medically necessary. You will only qualify for home care if part-time or intermittent skilled nursing care is needed, as mentioned above. If you have questions, ask your doctor or call Medicare at the number at the bottom of this page. To find out how much your test, item, or service will cost, talk to your doctor or healthcare provider.

The term “part-time” or intermittent means skilled nursing and home health care services provided any number of days per week, provided that less than 8 combined hours per day and 28 hours or less per week are provided (or, subject to case-by-case review as to the need for care, less than 8 hours a day and 35 hours or less a week). If you live in Massachusetts, Michigan, Florida, Illinois, or Texas, you could request a Medicare demonstration program. The care provider will alert the person receiving these services of any outstanding costs before treatment begins. The home health agency must give you a notice called Advance Beneficiary Notice (ABN) before giving you services and supplies that Medicare doesn't cover.

Supplemental insurance could help cover costs you may accrue, such as personal care, meals delivered to your home, and the remaining costs of your DME. To qualify for home health benefits under original Medicare, the person must have a relevant diagnosis and prescription from a qualified medical professional. However, they must also meet certain criteria, such as needing rehabilitation therapy or short-term skilled nursing care to treat an illness or injury and remain confined to their home. The main step in obtaining approval for home care is that you and the nursing plan must be under the care of a Medicare-approved doctor.

Your doctor or other healthcare provider may recommend that you get services more often than Medicare covers. .

Michele Maslen
Michele Maslen

Caregiver forever, heart for seniors, loves music, dancing, and putting smiles on people's faces.