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Taking the guesswork out of your plan!

Home Health Care Benefit Eligibility

Medicare Part A and/or Medicare Part B covers eligible home health services like Intermittent skilled nursing care, Physical therapy, Speech-language pathology services, Continued occupational services, and more.

Usually, a home health care agency coordinates the services prescribed by the doctor for the Medicare beneficiary. Medicare doesn't pay for 24-hour-a-day care at home, Meals delivered to a home, Homemaker services or Personal care. Medicare will help pay for a Medicare beneficiary’s home care if all four of the following are true:

1. They are considered home-bound. Medicare considers a person home-bound if they meet the following criteria:

 They need the help of another person or special equipment to leave their home or their doctor believes that leaving their home would be harmful to their health; and it is difficult for them to leave their home and they typically cannot do so.

2. They need skilled care. This includes skilled nursing care on an intermittent basis. Intermittent means they need care as little as once every 60 days to as much as once a day for three weeks (this period can be longer if they need more care but their need for more care must be predictable and finite). This can also mean they need skilled therapy services

3. Their doctor signs a home health certification stating that they

qualify for Medicare home care because they are home-bound and need intermittent skilled care

 As part of the certification, doctors must also confirm that they have had a face-to-face meeting with the Medicare beneficiary related to the main reason they need home care within 90 days of starting to receive home health care or within 30 days after they have already started receiving home health care.

4. They must receive their care from a Medicare-certified home health agency.

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