Information About Medicare Home Health Service

Medicare is the health insurance program administered by the federal government that offers the elderly and disabled populations access to affordable hospital, outpatient and prescription drug coverage. Home health care is one of dozens of services available to the millions of Medicare beneficiaries nationwide.

Definition

• Home health agencies were designed to help those with debilitating disease and injuries. Rather than place them long term in hospitals, home health agencies give them a sense of independence by allowing them to stay at home to receive their care. Home health care helps these patients with medically necessary therapies and personal care.

Coverage

• Medicare will cover home health services if certain criteria are met. First, the patient needs to be considered homebound, meaning leaving the home requires a great deal of effort. Homebound does not mean that the person never leaves the home. Running errands or going to doctor's appointments will not disqualify someone as homebound and neither will attending special events or ceremonies.

  In addition to being homebound, the patient's doctor must also order skilled nursing therapy or care for the patient. Examples of skilled therapy include physical, occupational and speech therapy. Finally, Medicare will only cover home health care if the agency the care is received from is Medicare-certified.

Available Care

• The Medicare home health benefit covers skilled nursing care and therapy under a registered nurse or a supervised assistant. Skilled therapy such as physical, occupational and speech therapy is administered by a skilled, trained therapist that specializes in the field. Medicare will also offer personal care for those who need it if they also require skilled care. A home health aide provides skilled care. Any other services needed, such as social services or medical services, are available to the patient.

Payment

• Typically, Medicare Part B, the outpatient benefit, pays for home health care. The exception to this is if the patient was treated in a hospital or a skilled nursing facility immediately before beginning the home health treatment. If treatment began within 14 days after discharge from a hospital or nursing facility, then Medicare Part A, the hospital benefit, pays for the first 100 days of treatment. After the first 100 days, Part B begins to pay.

Time Frame

• To receive the home health agency benefit, the patient must first get a doctor's approval. The doctor must then write out a plan of care with the home health agency's medical director. The plan of care lasts 60 days. Every 60 days, the doctor and the home health agency medical director will need to revisit the plan of care, reassess the patient's health and reconfirm that he is in need of home health care. As long as the doctor continues to write the plan of care, Medicare should pay for the benefit.