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Am I Eligible for Home Health Care?

When it comes to eligibility, either your physician or care provider will determine whether you’re eligible for home health care. In the majority of cases, if you’re considered eligible, then your insurance will likely cover all the expenses.  

Home health care is used as a treatment for a variety of situations, from post-surgical care to specialized therapy and more. For you to be considered eligible, there are certain qualifications you have to meet.

Medicare is typically the most common insurance used in home health care. Below are their eligibility requirements for home health care, from Medicare.gov.

Eligibility Requirements

Medicare covers eligible home health services like these:

Usually, a home health care agency coordinates the services your physician orders for you. Medicare does not pay for the following services, which are often provided through Private Duty companies:

  • 24-hour-a-day care at home
  • Meals delivered to your home
  • Homemaker services (like shopping, cleaning, and laundry), when this is the only care you need
  • Custodial or personal care (like bathing, dressing, or using the bathroom), when this is the only care you need

Who’s Eligible?

All people with Medicare (either Part A and/or Part B) who meet all of these conditions are covered:

  • You must be under the care of a doctor, and you must be getting services under a plan of care created and reviewed regularly by a doctor.
  • You must need, and a doctor must certify that you need, one or more of these: 
    • Intermittent skilled nursing care (other than drawing blood)
    • Physical therapy, speech language pathology, or occupational therapy. These services are covered only when the complexity of the service is such that it can be performed safely and/or effectively only by or under the general supervision of a skilled therapist and the treatment is specific, safe and an effective treatment for the your illness or injury. To be eligible, the skilled services must also be: (1) reasonable and necessary to the treatment of your illness or injury or (2) restoration of your illness or injury or (3) maintenance of function affected by your condition
  • You must be confined to the home (homebound), and a doctor must certify that you are homebound

You're not eligible for the home health benefit if you need more than part-time or "intermittent" skilled nursing care. You may leave home for medical treatment or short, infrequent absences for non-medical reasons, like attending religious services. You can still get home health care if you attend adult day care.

Source: Medicare.gov; CMS.gov

*Information as of April 9, 2020

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