How Medicare covers home health services
A couple of years ago, my father, well into his 70s, finally bought himself a high-performance automobile.
The kids and grandkids had all grown up, so there was no need for a larger car. And heck, he had waited a long time to drive something fun.
All was fine with the new car until my mother broke her hip, had surgery, and needed extensive outpatient physical and occupational therapy.
Getting into and out of a sporty car isn’t easy for someone using a walker and cane. So I got a phone call asking what could be done. (Actually, I think he was angling for my new minivan, whose video screens would give him something to do during mom’s therapy sessions.)
But I told him he didn’t need to take mom to a clinic or hospital. As a Medicare beneficiary, she could receive most of the therapy in her own home.
Medicare covers a variety of heath care services that you can get in the comfort and privacy of your home. These include intermittent skilled nursing care, physical therapy, speech-language pathology services, and occupational therapy.
Such services used to be available only at a hospital or doctor’s office. But they’re just as effective, more convenient, and usually less expensive when you get them in your home.
To be eligible for home health services, you must be under a doctor’s care and receive services under a plan of care established and reviewed regularly by a physician. He or she also needs to certify that you need one or more home health services.
In addition, you must be homebound and have a doctor’s certification to that effect. Being homebound means leaving your home isn’t recommended because of your condition, or your condition keeps you from leaving without using a cane, wheelchair or walker; special transportation; or getting help from another person.
Also, you must get your services from a Medicare-approved home health agency.
If you meet these criteria, Medicare pays for covered home health services for as long as you’re eligible and your doctor certifies that you need them.
For durable medical equipment (like a walker or wheelchair), you pay 20 percent of the Medicareapproved amount.
Skilled nursing services arecovered when they’re given on a part-time or intermittent basis. In order for Medicare to cover such care, it must be necessary and ordered by your doctor for your specific condition. Medicare does not cover full-time nursing care.