WASHINGTON – Home health care is a wide range of health services that may be offered in your home because of an illness or injury. Home health care is usually cheaper, more convenient and just as effective as care in a hospital or a qualified care facility (SNSF).
In general, the goal of home health care is to treat an illness or injury in order to get better, regain independence, and become as self-sufficient as possible. Home health care can also help you maintain your current condition or level of functioning, or slow the decline.
Medicare pays you when you meet certain eligibility criteria and when the benefits are deemed appropriate and necessary to treat your illness or injury.
If you have Medicare, you can use your home health benefits if:
1. You will be cared for by a doctor and receive services as part of a care plan that is regularly drawn up and reviewed by a doctor.
2. You need one or more of the following, and a doctor will confirm that you need them:
• Temporary qualified care (except for blood sampling)
• Speech pathology services
• Continuation of occupational therapy
• Home Health Aide Services (only if you receive qualified care)
• Medical social services
• Medical supplies such as wound dressings, if your doctor orders them as part of your care
3. The home health agency that takes care of you is Medicare approved.
4. A doctor confirms that you are home. To be home means:
• You have trouble leaving your home unaided (for example, with a cane, wheelchair, walker or crutches, special means of transport, or the help of another person) because you are sick or injured. Leaving your home is not recommended due to your condition.
• You normally cannot leave your home, but great effort will be required to do so.
You can leave home for medical treatment or short, infrequent absences for non-medical reasons, e.g. B. an occasional trip to the hairdresser, a walk around the block or a drive, or attending a family reunion, funeral, graduation, or other rare or infrequent event. You can still get home care when attending an adult daycare or church service.
5. As part of your certificate of eligibility, a doctor, or certain health professionals working with a doctor such as a nurse, must document that they had a personal visit to you within the required time frame. The visit was related to the reason you were receiving home care need.
If you only need qualified care but need more than “temporary” qualified care, you are not eligible for home health services. To determine whether you are eligible for home care because of a medically foreseeable recurring need for skilled care, Medicare defines “intermittent” as skilled care that is needed or either given:
• Less than 7 days a week.
• Less than 8 hours a day for up to 21 days. Medicare may exceptionally extend the three-week period if your doctor can predict when your need for skilled daily care will end.
If you are expected to require full-time qualified care for an extended period of time, you are not eligible for home health benefits.
Mike Zimmer is President of Bay State Insurance Agency Ltd. in Centerville. He is available to answer questions about Retirement, Medicare, Medicare Supplements, Medicare Part D (Prescribing Plans), Dental, and Vision Plans. He can be reached at 410-758-1680. For updates and more information, visit and like the Bay State Insurance Agency, LTD Facebook page.