Home Health Medicare Guide

Most people aged 65 and older qualify for Medicare. Medicare is a federal health insurance program designed to be used primarily by senior citizens. People younger than 65 may also qualify if they have certain kinds of health conditions. Traditional Medicare, called Part A and Part B, provide certain home health services and at-home hospice care. However, in order for Medicare to cover these services, beneficiaries must meet certain conditions.

Part A

• Once you qualify for Medicare, the first part you enroll in is Part A. You cannot enroll in any other part of Medicare without having Part A. Part A is also called hospital insurance, since it mostly helps to cover inpatient services and long-term care. However, home health and hospice care are also included in Part A. Part A is often premium-free. If you don't qualify for premium-free Part A, you may be able to join by paying a monthly fee.

Kinds of Home Health Benefits

• Once you have Part A, you are eligible for home health coverage. Medicare includes benefits for home-based physical therapy, speech therapy, skilled nursing care and social services. If you are diagnosed as being in the last six months of a terminal illness, you can also receive palliative nursing care, medications and respite care through the home hospice benefit.

Eligibility

• You cannot simply decide to stay home and receive your health care services. In the cases of both home health and hospice, a doctor must order your care. You must need skilled nursing care or physical therapy. Your doctor must also make a plan for your home treatment. In the case of home health services, you must be considered homebound, meaning that leaving your house a difficult undertaking. If you need hospice care, your doctor must certify your condition and you must personally sign a statement choosing hospice over other kinds of care. Both hospice and home health services must be provided by agencies that are approved by Medicare.

Ineligible Services

• Medicare does not cover all the things you may need for home health. As of the end of 2010, Medicare will not pay for 24-hour home health care or personal care given by nursing assistants if this is the only kind of care you need. Medicare will also not pay for homemaking duties such as laundry, shopping or cleaning, or for meals that are delivered to your house.

Medicare Advantage

• If you receive Part A Medicare through a private insurance company's Medicare Advantage plan rather than through the government, you may receive additional benefits. Medicare Advantage (MA) plans are required to offer all the same benefits as traditional Part A and B except for hospice care. They may have more home health benefits and restrictions, however, so if you have MA, be sure to check your policy carefully and check with your insurance company to determine what home health benefits you are entitled to and under what conditions.