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How can I qualify for the Medicare home care benefit?

Joane Goodroe
Nursing

To see a full list of Medicare Coverage, please go to the following website: http://www.medicare.gov/coverage/home.asp.

If you have specific questions, call the number listed on their website. 

Most Americans over age 65 are eligible for the federal Medicare program. Some people under the age of 65 may be eligible due to disability. To qualify for home care, a person with Medicare must meet all of the following:
  • Your doctor must decide that you need medical care at home and make a plan for your care at home.
  • You must need at least one of the following either part time or on and off: skilled nursing care, physical therapy, speech-language therapy, or occupational therapy.
  • You must be homebound and unable to leave the house without help. To be homebound means that leaving home takes a good deal of effort. But leaving home for medical treatment or short non-medical trips (such as for haircuts or religious services) do not usually disqualify you.
If you meet all the above requirements, you may be eligible for services provided by a Medicare-certified home health agency. Depending on your condition, Medicare may pay for:
  • Skilled nursing visits
  • Physical, occupational, and speech therapies
  • Medical social services
  • Medical equipment and supplies
If one of these skilled services is needed, home care aide services may also be provided as part of home care for the illness.
The doctor who refers you for home care must sign off on your plan of care and review it regularly. Except for hospice care, the services you get must be part-time and provided through a Medicare-certified home health agency in order to qualify for payment. For more information on Medicare and home care, you can order the booklet, Medicare and Home Health Care by calling Medicare, or you can read it on their Web site. The booklet contains a checklist to help you choose an agency and a second checklist to help you evaluate its quality.
Not all home care agencies are certified to provide care to people with Medicare. Those that are certified have met federal requirements for patient care. This allows them to provide home health services to patients covered by Medicare and Medicaid. Due to legal requirements, the agencies must report to Medicare, and their services are watched and controlled.
Medicare also covers hospice services for people with cancer who are expected to live for 6 months or less. For hospice coverage, you are not required to be homebound or in need of skilled nursing care. Call Medicare or visit their Web site to find out more about the Medicare Hospice Benefit.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.