Who Qualifies for Medicare Home Care?
If your loved one could benefit from home health care, you may be wondering how they can qualify for these services? The purpose of home health care is to help patients and families function safely, and or recover in the home, rather than the hospital or rehab center. Home health care can assist with new or worsening symptoms, or help in recovering from a recent surgery or a long-standing chronic illness such as CHF, COPD or diabetes.
We know how important your loved one is to you. If you have questions pertaining to home health care, please give us a call to review but first contact should always be made with your personal care physician.
4 Things Needed to Qualify for Home Health Care
Home health care needs are tricky when it comes to insurance. If your loved one requires personal care (i.e., bathing, dressing, toileting) and not skilled care, Medicare will not pay. But, if your loved one needs skilled care, personal care will be included. You can, however, pay for these services on your own.
Here are the four criteria your parent must meet to qualify for the home health benefit:
- They are homebound. Medicare will consider your family member homebound if they need help from a person or special equipment (i.e., walker, wheelchair) to leave the home and/or if the doctor feels it would be dangerous. Essentially, if it’s physically difficult for your loved one to leave the home, they are considered homebound.
- They need skilled care. Medicare will pay for home health care if your loved one qualifies and needs skilled care, on an intermittent basis. Skilled care includes nursing, physical, speech and occupational therapy if necessary for treating an illness or condition.
- The doctor has signed a certificate. Your parent’s doctor will need to sign prescription stating that they need and qualify for Medicare home care. The reasons for the doctor’s recommendation include being homebound and needing a skilled clinical service in the home. A treatment plan also needs to be created by the doctor and reviewed regularly.
- Care is received from a Medicare-certified home health agency. Understandably, Medicare wants you to choose a reputable home health care provider.
What Services Will Medicare Cover?
If your loved one meets the above four criteria, they qualify for Medicare home health care and can receive a wide range of services. The type of care your parent receives will be based on their needs. Fortunately, home health care is designed to treat acute changes in patient’s conditions, so you can expect your family member to receive highly personalized care at all times.
Let’s review the types of services that Medicare will cover when home health care in the home is needed:
- Skilled nursing services
- Skilled therapy services
- Home health aide
- Medical social services
- Medical supplies
The best place to start is with your loved one’s doctor. Talk to them about your parent’s condition and whether home health care would benefit their quality of life.