How to Get Medicare Home Health Care
This page shows how to get Medicare to cover Home Health Care. The video (left) also outlines these steps.
How To Get Medicare Home Health Care
Original Medicare can cover the full cost of medically necessary home health care on a limited basis for beneficiaries who are unable to leave home without assistance, including skilled nursing care, therapies, and aide services.
For more information on what Medicare and other providers pay for, how to qualify, how to check if a Medicare plan covers home health care, and how to get started, click here.
What is the process of getting Medicare home health care?
The video above also outlines the following steps to getting home health care:
Step 1: See Doctor
Most often an injury or health emergency requiring home health care is unexpected (e.g. heart attack or fall), but for seniors who wish to age in place, the need for home care services and home health care can be foreseen and thus prepared for.
Home health care is typically short-term health services and equipment for individuals while they are home-bound after injury.
Long-term care, often called custodial care, is available at home but is not covered by Original Medicare, though it may be covered by supplemental Medicare plans. Many states do cover long-term home care as well as other government programs such as the VA and PACE. To find out what coverage a patient qualifies for, go to https://eldercare.acl.gov/Public/Index.aspx
NOTE: It is vital that the doctor completes and documents an in-person visit with the patient either:
Three months before the start of Home Health Care services begin
Within one month after the Home Health Care benefit has begun
Step 2: Get A Plan - Specifically, A Home Health Care Plan
The doctor will provide a Home Health Care Plan (HHC Plan) that should include:
Which health care professionals should give these services
How often the services are needed
Medical equipment needed
Results the doctor expects from treatment
The home health agency staff will teach the patient (and family or friends who are helping to care for the patient) to continue any care needed, including:
How to manage condition
Step 3: Contact Medicare
Medicare only covers care for specific services. These services include physical therapy, occupational therapy, speech-language pathology services, medical social services, durable medical equipment, medical supplies, and skilled nursing services provided in-home.
Original Medicare covers home health care services fully, for short periods of time. However, it may not cover 20% of the Medicare-approved amount for durable medical equipment; cost and benefits may be different for beneficiaries enrolled in Medicare Advantage plans, so check with each plan to find out how they provide Medicare-covered home health benefits.
Caution: Be sure to ask up front, the home health care provider selected which services Medicare will pay for and what is not covered, as some providers may recommend services not covered by Medicare. Home health providers must notify you of the cost of services in writing before starting care.
Step 4: Select Provider
To find the right provider, click FIND A CAREGIVER to find an accredited home health care provider that has passed continual quality checks. Then, make sure the provider is on the Medicare approved list of providers: https://www.medicare.gov/homehealthcompare/search.html.
Just because a provider has been approved by Medicare does not mean it has been accredited by one of three federal accrediting bodies.
These accreditation bodies ensure home health providers continually pass quality checks, only hire (and keep) the best employees, and more.
For more information on why accreditation matters, click here.
Step 5: Assessment
To find the right provider for your situation, you'll want to ask questions such as the following:
Can I interview multiple Caregivers?
Can I interview caregivers who specialize or have experience in my injury or medical status?
Can the provider offer resumes, references and reviews for the caregiver, not the agency itself?
What is the agency’s plan for back up resources?
How much does the caregiver earn per hour?
Step 6: Re-Assess
Finding home health care can be daunting. Once a patient has found a provider, the tendency may be to assume all is well. This is not always the case. Ensure your HHC provider is aware of the need for re-assessment. Ensure the provider is planning to send updates on a regular basis, which will inform the re-assessment when it occurs.
Quality of care is paramount. Be prepared to re-assess the options quickly, if the need arises.
By The Team At Accredited Home Health Care