Who is Eligible?
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Who Is Eligible for the Home Health Care Benefit?

Under Medicare, candidates for home health care must:

  • Have Medicare Part A or B;

  • Be homebound – leaving home must require a considerable and taxing effort;

  • Require skilled nursing services or skilled therapy services. Patients who qualify based only on their needs for skilled nursing must either require it fewer than seven days a week (even as little as once every 60 to 90 days) or need daily (seven days a week) skilled services for a finite and predictable period of time;

  • Get services from a Medicare certified home health agency (HHA); and

  • Get a doctor's plan of care.

As long as patients meet these eligibility requirements, they may continue to receive home health benefits indefinitely. Home health care need not be rehabilitative or of finite duration. Patients with chronic or terminal conditions, without specific diagnoses, or without recent hospital discharges can still qualify if they need skilled care. For example, a person with multiple sclerosis who requires skilled maintenance therapy indefinitely can make continuous use of the Medicare home health benefit.

How to Obtain the Medicare Home Health Benefit

  • Patients must be certified by their physicians to meet the eligibility requirements for coverage. The patient's doctor must draw up a plan of care specifying the nature, frequency and duration of care needed.

  • A Medicare-Certified Home Health Agency (HHA) must then approve the plan of care. The plan of care can only cover 60 days of care, but the doctor can draw up a new plan of care at the end of the 60 days to extend home health coverage if the patient still meets eligibility requirements.

    NOTE: Doctors often do not know that under Medicare it is up to them to design the plan of care. They routinely rely on the HHA to tell them what Medicare will cover, which may not always be in the patient's best interest. It may be up to you to inform the doctor that she has the final word on what care her patient needs.

If the patient is hospitalized, speak to the hospital social worker or discharge planner. Ask one of them to arrange for a HHA to assess the patient during hospitalization and to care for the patient after discharge.

If the patient is at home, have his or her physician contact the HHA directly to explain the nature, frequency and duration of the skilled and home health aide services required. The physician should send a letter to the HHA along with a plan of care. The HHA will send a nurse to evaluate the patient.
Home Health
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Home Health
Home Health