Medicare
- Do I qualify for home care under Medicare?
- What services are covered under Medicare and/or Private Insurance?
Do I qualify for home care under Medicare?
To qualify for Medicare home health coverage, you must meet all four of the following conditions: Your doctor must determine that you need medical care in your home and prepare a plan for care at home. The care you need must include intermittent (not full time) skilled nursing care, physical therapy or speech language pathology services. You must be home bound. This means you normally are unable to leave your home. If you do leave your home, it is with considerable and taxing effort. Absences from home must be infrequent, of short duration, or to get medical care. You can still be considered home bound if you occasionally go to the barber or beauty shop, go for a walk around the block, religious services, or a short drive. The agency you choose to provide your services must be approved by the Medicare program.
What services are covered under Medicare and/or Private Insurance?
If you meet all four of the conditions to qualify for home care, Medicare will pay for:
Skilled Nursing care either on an intermittent or part-time basis. Skilled nursing includes services and care that can only be performed safely and effectively by a licensed nurse.
Home Health Aide either on an intermittent or part-time basis. Home Health Aide services include assistance with personal care such as bathing, transfers, or dressing.
Physical Therapy as often and for as long as it is medically necessary and reasonable. Physical Therapy includes exercise to restore movement and strength to an injured arm or leg, and training in transfers and safe ambulation.
Speech Language Pathology as often and for as long as it is medically necessary and reasonable. This type of therapy includes exercises to restore speech.
Occupational Therapy as often and for as long as it is medically necessary and reasonable, even if you no longer need other skilled care. Occupational Therapy helps you to achieve independence in daily living by learning new techniques for eating, dressing, and performing other routine tasks.
Medical Social Services to assess the social and emotional factors related to your illness, counseling based on this assessment and searches for available community resources.
Medical supplies like wound dressings.
Medical Equipment. Medicare pays 80 percent of the approved amount. An example of medical equipment would be a wheelchair or walker.