Who Qualifies for Home Health Services?

Most patients, including Medicare beneficiaries, are eligible for home health services when the patient is under the care of a physician who has certified that the patient is homebound and in need of one of the following services:

• Intermittent skilled nursing care; and/or
• Physical, Occupational, or Speech Therapy when:
  1. your condition is expected to improve in a reasonable and generally-predictable period of time;
  2. you need a skilled therapist to safely and effectively make a maintenance program for your condition; or
  3. you need a skilled therapist to safely and effectively do maintenance therapy for your condition.

When is a patient homebound?

A patient is homebound when the patient is generally confined to their home due to an illness or injury. Homebound patients may still leave their home, but leaving the home must require supportive devices, such as a wheelchair, or the assistance of another person.

Homebound patients typically leave the home only for: (1) medical treatment; (2) adult day care; or (3) short infrequent absences, such as attending religious services.

Who does not qualify for home health?

Patients who are not bound to living at home and patients who need more than part-time or occasional nursing.

Who Pays for Home Health?

For Medicare and Medicaid beneficiaries, covered home health services are provided at no cost to the patient.

Some patients covered by private insurance will be responsible for copays for certain home health services. Most commercial insurance companies cover home health services with little or no out-of-pocket expense for the patient. If you have questions about what home health services are covered by your insurance company, please give us a call at 1-866-330-0609.

Who qualifies for Medicare coverage?

To qualify for Medicare coverage, the patient must satisfy one of the following requirements:

• Be 65 years old or older
• Suffer from permanent kidney failure
• Receive Social Security benefits or be enrolled in the railroad retirement system
• If the patient is younger than 65 years old, the patient must have received Social Security disability benefits for at least two years (24 months).

If a patient is 65 or older and still working, will Medicare pay for home health service?

Yes, a patient can use Medicare. However, if a patient is covered by an employer’s insurance plan, the employer’s health insurance could be used in conjunction with Medicare.

Are home visits covered under Medicare?

Yes, if each of the following conditions is met:

• The patient’s physician has requested home healthcare and established a plan of care
• The agency is Medicare-certified
• The patient is homebound, meaning the patient cannot leave home without assistance
• The patient requires nursing care, physical therapy or speech therapy that is reasonable and necessary throughout the patient’s episode of care.

Does Medicare cover physical, occupational, and/or speech therapy?

Yes, if the physician refers the patient and the patient qualifies for therapy.

Are services for mental illness covered?

Yes, if the patient qualifies for home healthcare under Medicare.

Still Have Questions?

If you believe you or a loved one qualify for home health services and would like to learn more about ProHealth, please pick up the phone and give us a call at 1-866-330-0609, or stop by one of our locations. We would love to talk to you about the personalized home health services we provide and can also answer questions about what health services are covered by your insurance or Medicare benefits.