Provider Requirements · A healthcare provider (such as a nurse practitioner) must evaluate you face-to-face before certifying that you need home health services. Medicare covers certain home health care services if you qualify. Before you start getting home health care, the home health agency must tell you how much Medicare will pay. The agency must also let you know (both verbally and in writing) if Medicare won't pay for the items or services it provides and how much you'll have to pay for them.
The home health agency must give you a notice called Advance Beneficiary Notice (ABN) before providing you with services and supplies that Medicare doesn't cover. If you receive your Medicare benefits through a Medicare Advantage (Part C) plan or another Medicare health plan, check with your plan for more information about your home health benefits. If you have a Medicare Supplemental Insurance (Medigap) policy or other health insurance coverage, let your doctor or other provider know so that your bills are paid correctly. In most cases, if it's part-time or intermittent, you may be able to receive skilled nursing care and home health care services for up to 8 hours a day (combined), for up to 28 hours a week.
You may be able to receive more frequent care for a short period of time (less than 8 hours a day and no more than 35 hours a week) if your provider decides that it's necessary. You won't qualify for home health care services if you need more than intermittent or part-time specialized care. You can leave home for medical treatment or brief, infrequent absences for non-medical reasons, such as attending church services. You can still get home health care if you attend adult day care.
First things first: you must be enrolled in Medicare. Specifically, you must have Original Medicare (consisting of Parts A and B) or Medicare Advantage (Part C). Part A covers inpatient hospitalizations, care in a skilled nursing facility, palliative care, and some home health care services. Part B covers medically necessary services, such as doctor visits, outpatient care, and some home health care services. Ask the home health agency what services Medicare will pay for and which aren't covered, since some agencies may recommend services that Medicare doesn't cover.
With the many threats currently facing the Medicare program, now is the time to come together as partners and explore ways to advocate for comprehensive Medicare coverage, health equity and quality health care. If you are eligible for home health care, you can receive skilled nursing and rehabilitation services from approved home health agencies. If you qualify for the Medicare home health benefit, your doctor will document your needs and sign a home health care certificate. With the right support, you can make the most of Medicare home health benefits and enjoy a better quality of life in the comfort of your home. Home health care is often less expensive, more convenient, and as effective as the care you receive in a hospital or skilled nursing facility (SNF).
The documents will also include a care plan that notifies Medicare and health care agencies of the services and equipment you'll need while you're being treated. The Medicare home health care benefit is not a long-term service and support program, and it doesn't provide unlimited coverage. You are generally not eligible for Medicare home health benefits if you need full-time skilled nursing care for an extended period of time. Medicare home health care is designed to provide specialized care, meaning that the services you need can only be provided by a licensed health professional. Contact the person's doctor and other providers, let them know what's happening, and ask them to support the need for home health services.
Under Medicare Part B, you are eligible for home health care if you are homebound and need specialized care, even if you haven't been hospitalized before. Before you start getting home health care, the home health agency must tell you how much Medicare will pay.
