As you review your health options, you may be looking at home health care as an opportunity for you or your loved one to stay independent for longer. Home health care allows medical professionals such as nurses, therapists, medical social workers, and more to provide medical care to you in your home. It’s a great option for many seniors who need medical care but desire to receive care in the privacy of their home.
Home health care is sometimes covered under Medicare Part A. Your situation must meet certain criteria in order to be covered.
What is Medicare Part A and What is Covered?
Medicare Part A is a federally funded medical coverage available to seniors and certain disabled Americans. The coverage applies to hospital expenses, which includes nursing care and hospital stays, as well as some home health services, skilled nursing care, and hospice services.
Medicare Part A does not have a monthly premium because you paid for it with payroll taxes while you were employed. It has an annual deductible that must be met before coverage applies. Generally, the plan pays a percentage of the Medicare-approved amount for medical expenses. However, when it comes to home health care, Medicare usually pays 100% of the cost if you are eligible.
In order to use Medicare Part A for home health care, your medical condition and living situation must meet the following criteria:
- You must require intermittent skilled care, physical therapy or speech therapy.
- You must meet homebound criteria defined by Medicare guidelines.
- You must currently be under a physician’s care. A physician must order all home health services.
How to Know if You Meet the Home Health Care Criteria
As you evaluate your circumstances, it’s important to know how to define each of the eligibility criteria so you can understand whether you qualify.
The definition of homebound is the first thing to consider. There are two criteria in Medicare’s definition of homebound.
- You need the help of another person or medical equipment such as crutches, a walker, or a wheelchair to leave your home; or your doctor believes your health or illness could get worse if you leave your home.
- It is difficult for you to leave your home and you typically cannot do so.
In either case, your doctor will need to certify you as being homebound before Medicare will accept home health care claims. Leaving home for medical treatment, religious service, or adult day care does not endanger your homebound status. Neither do occasional trips to a barber or hair salon.
Next, the nature of the care you need will be examined. You will need to be currently under the care of a physician for your medical needs, and you must need skilled medical care. These needs must be reasonable and medically necessary. Finally, your care needs must be intermittent – Medicare Part A is not designed for home health care to take the place of a full-time nursing facility.
To discuss your home health care needs in detail, or if you have questions about your coverage under Medicare Part A, we are here to help. Contact the Team Select Home Care location nearest you, and we’ll help you fully explore your home health care options.