Many do not realize the full range benefits offered through traditional
Medicare. And, when sifting through a Medicare handbook or perusing
the web, explanations of these services can be complicated. The below
FAQ was designed to provide clear, easy to understand answers to the
most commonly asked questions about home health care.
1) What is home health care?
Many health care treatments that were once offered only in a hospital or a doctor’s office can now be done in your home. Home health care can be just as effective as care provided in a hospital or skilled nursing facility. Home health care is designed to provide treatment for an illness or injury with the goal of regaining your independence. Home health care may also help you maintain your current function and slow the decline resulting from a progressive or chronic condition.
Medicare allows for home health care services if you meet certain eligibility requirements, and the services are considered reasonable and necessary for the treatment of your illness or injury.
2) What health conditions are commonly treated by home health care providers?
- Joint replacements
- Neurological conditions
- Falls/fall risk
- Chronic pain
- Heart failure
3) Under what circumstances will Medicare cover home health care?
- You must be under a physician’s care, and receiving services under a plan of care established and reviewed regularly by a doctor, and
- A physician certifies that you require one or more of the following: skilled nursing care, physical therapy, speech-language pathology services, occupational therapy, and
- The home health agency providing your care is Medicare-certified, and
- A doctor certifies that you are homebound, and
- There is a documented face to face encounter with the prescribing physician, physician assistant, or nurse practitioner. The encounter must be related to the reason you need home health care.
4) What does homebound mean?
- It means that you have trouble leaving your home without help (e.g. use a cane, wheelchair, walker, or crutches, require special transportation, or help from another person) because of an illness or injury, or leaving your home isn’t recommended because of your condition.
- You’re normally unable to leave your home and doing so, requires major effort.
- It is permissible to leave home for medical treatment or short, infrequent absences for non-medical reasons. Examples include an occasional trip to the barber, a walk around the block or a drive, or attendance at a family gathering.
- Attendance at adult day care or religious services does NOT disqualify you from receiving home health care.
5) Do I only qualify for home care after having been in a hospital?
No, hospital admission is not necessary. You can qualify for home health care if you are homebound and provided all the other conditions have been met.
6) What is not covered by Medicare?
- 24-hour-a-day care at home
- Homemaker services, like shopping, cleaning, and laundry
- Custodial or personal care like bathing, dressing, and using the bathroom when this is the only care you need
- Meals delivered to your home
- Wellness exercise and personal training services
7) Are professional therapy services available under Medicare only for patients who are improving, or expected to improve?
No. Services rendered by physical, occupational, and speech and language therapists are covered by Medicare to maintain a patient’s condition or to prevent or slow the patient’s decline and deterioration, regardless of the patient’s underlying illness, disability, or injury. Skilled therapy services are covered when the specialized judgment, knowledge, and skills of a qualified therapist are necessary for performance of a maintenance program.
8) Do I have a choice in who provides my home health care?
Yes! The Social Security Act ensures that free choice is guaranteed to all Medicare patients. It states: “Any individual entitled to insurance benefits under this Act may obtain health services from any institution, agency, or person qualified to participate under this Act if such institution, agency, or person undertakes to provide him/her such services.”
You are free to choose provider of choice for home health services.
9) Where can I find more information about Medicare coverage and home care?
- Medicare website: https://www.medicare.gov/Pubs/pdf/10969-Medicare-and-Home-Health-Care.pdf
- Center for Medicare Advocacy: http://www.medicareadvocacy.org/jimmo-v-sebelius-the-improvement-standard-case-faqs/