How do I qualify for Home Health?

I know someone who can benefit from this service. Now what?

How much does this service cost?

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What is Home Health?

Home health care is generally described as healthcare provided by licensed professionals inside the home. Home health care includes skilled nursing care, as well as other skilled care services, like physical and occupational therapy, speech-language pathology (therapy) services. Services may also include medical social services, and assistance from a home health aide (when needed by people also receiving skilled care).

These services are provided by a variety of health care professionals in your home. The home health staff provides and helps coordinate the care and/or therapy your doctor orders. In support of your doctor’s orders, home health staff develop a care plan, which is a written plan for your care. It tells what services you will get to reach and keep your best physical, mental, and social well being. You have a right to participate in planning your care and treatment. The home health staff keeps your doctor up-to-date on how you are doing and updates your care plan as needed. Home health agencies cannot make changes to the care your doctor orders for you without your doctor’s knowledge and permission.

The following criteria are required for Medicare to pay for your home health services:
You are homebound.  This means that due to your illness or injury it takes a considerable taxing effort for you to leave your home and your absences are infrequent or of relatively short duration.  You can still be considered homebound if you leave home to attend a religious service; to receive health care treatment, including regular absences to participate in therapeutic, psychosocial, or medical treatment in a state licensed/certified and/or accredited adult day-care program; or to attend unique or infrequent events (family reunion, funeral, graduation, etc.)  If you are able to drive, then you probably do not meet the homebound requirement.

You have had a recent illness or injury (or worsening of a condition) which requires Skilled Nursing Care on an intermittent basis, or Physical Therapy, Speech-Language Pathology or have a continuing need for Occupational Therapy.

You are an eligible Medicare beneficiary and under the care of a doctor who has ordered the treatment or services we are providing.  If the services are not reasonable or medically necessary and specifically ordered by your doctor, Medicare will not pay for those services.
Care is provided on an intermittent basis.  This means Medicare will not pay for our health care staff to stay with you for an extended period of time. We will only visit you for the length of time it takes to provide the specific treatment ordered by your doctor.

If all of these requirements are met, Medicare will also pay for medically necessary Occupational Therapists, Medical Social Services, Home Health Aides and medical supplies.