Medicare covers home health care services when a doctor certifies that:
- You need medical care at home, and
- You are homebound, and
- You need skilled care from a nurse or a skilled physical, speech, or occupational therapist.
Medicare will only cover home care services when your doctor:
- Orders the care from a home health agency that Medicare approves, and
- Documents a face-to-face visit with you up to 3 months before or 1 month after the start of the service, AND
- Signs a plan for your care.
What does homebound mean?
Being homebound means it is very difficult for you to leave home because of your condition. For example, Medicare may consider you homebound if you need a wheelchair or someone else’s help to leave home. Or if leaving home means you may be in danger or at increased risk. For example, a person with dementia may be in danger when leaving home because of memory loss or other cognitive impairment.
But, you can still meet the homebound definition even if you sometimes leave your home. You can leave for medical treatment you cannot get at home. You also can leave for non-medical reasons, if the trip is occasional and only for a short time. For example, you can go to religious services or to get a haircut. You also can be called homebound if you go to a medical adult day care program. This is because the medical day care programs are considered medical treatment. You cannot be called homebound if you go to a regular adult day care.
What does skilled care mean?
For you to get home care, your doctor must say that you need either skilled rehabilitation therapy or skilled nursing care. This means you must need professionals with special training and knowledge to care for you safely and well. These may include registered nurses, licensed practical nurses, physical or occupational therapists, and speech and language therapists.
How do I start getting home health care?
Your doctor has to write an order for home health care services. Usually he or she will refer you to a home health agency. Someone from the home health agency will visit your home. They will talk with you about your needs and health.
Agency staff will work with you and your doctor to write your plan of care. This plan should include:
- The types of care you need,
- Which health care providers should give this care,
- How often you need care,
- What medical equipment you need, and
- The results your doctor expects from your treatment.
You can get home health care for up to 60 days under your doctor’s first order.
Note: It is always helpful to talk to your doctor about the kinds of care you need before your doctor refers you to a home health agency. Talk with your doctor about choosing a home health agency that often works with patients who have dementia or Alzheimer’s. You should make sure the agency also has experience working with Medicare. Doing so will make sure you get the right home care and avoid Medicare payment problems.
How often and how long can I get these services?
You can keep getting home health care services as long as your doctor says you need them. But your doctor must renew the order at least once every 60 days. Many Alzheimer’s patients need certain ongoing rehabilitation therapies that Medicare’s home health care benefit covers.
If you qualify for Medicare home health care coverage, you generally pay nothing. Medicare usually does not charge deductibles or coinsurance for these services.
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