Medicare Part A will cover many of the costs associated with home health care if the care is both medically reasonable and necessary. If the patient is not entitled to Part A coverage, Part B may provide coverage.
How Is Eligibility Determined?
To be eligible for coverage, a patient must be confined to his or her home. Additionally, certain other criteria relating to the provision of services must be met.
General Requirements
First, a physician must determine that home health care is required. A physician must also set up a plan for the care. Second, the patient must require the intermittent provision of covered services, such as skilled nursing care, speech pathology, or physical therapy. Third, the services must be provided by an agency that participates in or contracts with Medicare.
Confinement
Additionally, a physician must diagnose a condition that produces confinement of the patient to his or her home. A patient need not be literally unable to leave the house under any circumstances. It is enough if the patient requires some form of external assistance to leave, such as by using a cane or wheelchair.
Patients with frequent or lengthy absences from their homes will not be considered confined under the Medicare standard. However, short-term, infrequent absences, such as those required to receive health care treatment or to attend religious services, will not result in ineligibility for home health care coverage. Participation in adult day care, in particular, will not disqualify a patient from coverage.
What Is Covered?
If a patient is eligible for home health services, Medicare will pay for the services themselves, as well as the cost of needed medical supplies. Medicare will also pay 80% of the cost of durable medical equipment.
Medicare home health care coverage will not pay for prescriptions, transportation, or prosthetic devices. It also will not cover services that are covered under Part A hospitalization coverage, housekeeping services, or medical social services provided to the patient's family members.
Copyright 2010 LexisNexis, a division of Reed Elsevier Inc.
