How to Work With Medicare to Get Home Nursing

Sometimes individuals who are covered under a Medicare health plan need help at home after they have been discharged from the hospital. Others might be dealing with the flare-up of a chronic illness. In these cases, Medicare may pay for some basic health care services that a person receives in the home. However, medical services in the home must be considered necessary to manage a health condition, and must be included in the patient's care plan. Consequently, there are criteria you must meet in order to qualify for coverage.

Instructions

• 1

  Before you can qualify to receive medical care in your home, you must be currently covered under Medicare and meet certain conditions. Your doctor must determine that you need health care services at home; you must be homebound; and you must need care on a part-time or intermittent basis. In addition, the home health agency you choose to provide that care must be Medicare-certified.

• 2

  Talk to your doctor about how to apply for home health care. He can help arrange for this care. A physician must also approve a plan of care that may cover up to 60 days of care at a time, providing the care is medically necessary.

• 3

  Inquire about the home health care services for which Medicare will pay. Medicare will pay for part-time skilled nursing care in your home. Skilled nursing care is defined as those services which can only be performed by a licensed practical or registered nurse. If you are receiving part-time or intermittent skilled nursing care, you may also qualify for personal care services provided by a home health aide.

• 4

  Find out about the home health services for which Medicare will NOT pay. Medicare will not pay for continuous 24-hour care at home or for meals delivered to your home. Other services Medicare does not pay for include homemaker services or personal care performed by a home health aide if this is the only care that you need.

• 5

  Understand that Medicare pays only for home health care services provided on a part-time or intermittent basis. This means that you must require care less than seven days a week or fewer than eight hours each day over a period of up to three weeks. You may not qualify if the length of time for which you will need the care cannot be determined before care begins.

• 6

  Choose a home health agency that is approved to participate in the Medicare program. The agency must draw up a plan of care detailing the kinds of services that will be provided, how often each of those services will be provided, and for how long the services will be provided. The plan should describe any home medical equipment you will need. A doctor must then approve the plan. Your plan of care will be reviewed periodically and modified if your medical condition warrants changes.