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Medicare and Insurance

Home health care provides medical treatment for an illness, injury or chronic condition with the goal of helping you recover, regain your independence and become as self-sufficient as possible, and is covered by Medicare and many private insurers.

Medicare Eligibility

For patients covered by Medicare, there are several requirements that must be met in order for them to qualify for home health care:

  • Your doctor must decide that you need medical care at home and make a plan for your care at home.
  • You must need intermittent skilled nursing care, physical therapy, speech-language therapy or continuation of occupational therapy.
  • You must be restricted in your ability to leave home “homebound”, and your homebound status must be certified by a physician.

Medicare will cover the following types of home health care:

  • Skilled Nursing
  • Home Health Aide
  • Physical, Occupational and Speech Therapy
  • Medical social services to help you with social and emotional concerns related to your illness. This might include counseling or help in finding resources in your community
  • Certain medical supplies, like wound dressings (but not prescription drugs or biologicals)
  • Durable medical equipment like a wheelchair or walker
  • Food and Drug Administration (FDA)-approved injectable osteoporosis drugs, in certain circumstances

What Medicare will not cover:

  • 24-hour-a-day care at home
  • Meals delivered to your home
  • Homemaker services like shopping, cleaning and laundry
  • Personal care given by home health aides like bathing, dressing and using the bathroom without the need for skilled nursing or therapy services at the same time

Medicaid and Insurance Eligibility

Many state Medicaid programs and commercial insurance plans offer full or partial home health care coverage. The eligibility requirements vary by state and by insurance company, so it’s best to contact your state Medicaid program or private insurer directly to learn about their specific requirements. Additionally, some Medicaid programs and private insurers may provide coverage for some services that Medicare does not.

Many times, your doctor, a social worker or a hospital discharge planner will help arrange for Medicare or insurance-covered home health care. It is your right to choose the home health company

you want so remember to say, “I want Kamcare”.