To be considered eligible for receiving home health services under Original Medicare, you have to meet the following conditions:
- You have a doctor’s prescription for home health care. A doctor should also establish and review your care plan on a regular basis.
- Your need for home health care must include part-time skilled nursing care or physical, speech, or occupational therapy.
- Your doctor must confirm that you truly require home care. In order to benefit from Medicare coverage, your doctor must create a care plan that includes all necessary services. For example, physical therapy, speech-language pathology, or ongoing occupational therapy services must be considered specific, secure, and efficient remedies for your situation and provided by a Medicare-certified home health agency.
- Your home health care provider must be an approved Medicare agency.
- You must have your doctor confirm that you are homebound. If you are confined to your home by an injury, illness, or another medical condition, you must be confined at home. Some people may not be eligible for treatment if they are able to leave their homes to receive it.
- With the home health care agency, your doctor must develop a care plan.
Previously, Medicare requirements required that home health care be expected to improve the patient’s condition, but this has now been changed so the patient can become eligible if it means that their condition is maintained or slowed down.
Although Medicare does not cover full-time nursing care, it might help with the costs of a skilled nursing facility if you need full-time nursing care.
What does Medicare pay for in 2022?
Medicare will pay for the full price of home health care services if they are associated with the following :
- Part-time skilled nursing care.
- Physical therapy
- Speech therapy
- Occupational therapy
- Home health aides
- Medical social services.
- Injectable osteoporosis medicines for women.
- Durable medical equipment and medical supplies for home use.
The following services are typically not covered:
- Home care is available 24 hours a day, seven days a week.
- Personal/custodial assistance, such as dressing, bathing, or toileting (if this is the only type of care you need).
- Cleaning, laundry, and shopping are examples of domestic services (if this is the only type of help you need).
- Meal delivery service.
As part of Medicare Part A, you will be compensated for 100 percent of your home health care costs. If your doctor recommends home care, Medicare will cover the initial evaluation to determine if you are a good candidate.
In the event of a subsequent hospital stay of at least three days, Part A of Medicare pays for home health care; otherwise, Medicare Part B (medical insurance) pays.
Medicare’s website has a search and comparison tool to help you find certified home health agencies in your area. If you have original Medicare, Parts A and B, you can choose any approved agency.
If you have a Medicare Advantage plan, you may have to use an agency that the plan works with. Before you start receiving care, the agency should let you know, verbally and in writing, whether some of the services they provide are not covered by Medicare and what you would pay for them.
Don’t worry. We’re here to help you understand everything: how to enroll, when your specific enrollment period is, what Original Medicare does and doesn’t cover. If you have questions, reach out to us for clear answers. You can count on us to help you understand your options for 2022, even if it means taking no action at all. Call us toll free at (866) 235-8378 or click here to email us your name and phone number for us to call you.