top of page
  • Mike Ligeti

How Do You Qualify For Homecare?

As you may have surmised from the title of this post, today, I will be talking to you about how you qualify for home care. The source I'm using is from the Centers for Medicare & Medicaid Services website, a .pdf file called "Medicare and Home Health Care". I'll be paraphrasing most of this, as it's pretty basic already, but at least you can use this blog as a one-stop-shop for medical news and information. Here are the requirements: 1. You must be under care of a doctor, and the services you get must be under a plan of care established and reviewed regularly by this doctor. 2. A doctor must certify that you need at least one of:

  • Intermittent skilled nursing care

  • Physical therapy

  • Continued occupational therapy

  • speech-language pathology services

3. The home health care agency taking care of you must be Medicare-certified, which, luckily, we are! 4. A doctor must certify that you are homebound, which means:

  • Leaving home takes "a considerable and taxing effort," and therefore leaving home isn't recommended because of your condition.

  • Your condition doesn't let you leave home without help from another person, a wheelchair or walker or other form of special transportation.

As for exceptions, you can leave for medical treatment or non-medical reasons, like religious services, so long as they are infrequent. Adult day care is allowed, but you still get the home care services in your home. So long as your doctor doesn't discontinue your certification for services, and so long as the care is needed less than 7 days per week or less than 8 hours a day for 21 days. Some exceptions are made under special circumstances, but they don't detail those here.

Reliance Nurse taking Blood Pressure for Patient

Just so you know, Medicare will cover nearly everything, so don't feel afraid of the cost of letting us help. There are only a few things Medicare doesn't cover:

  • Medical services or supplies that you agree to pay out of pocket for. Before you agree on this, we (or any other home care agency) would give you a Home Health Advance Beneficiary Notice.

  • 20% of the Medicare-approved amount for Medicare-covered medical equipment like oxygen equipment, walkers, and wheelchairs.

  • Private duty care(which we offer, Medicare just doesn't pay for it), like:

  • 24-hour-a-day care at home

  • Care (like bathing, dressing and using the bathroom) given by home health aides when this is the only care you need

  • Services not outlined by your plan of care, like housemaking services (shopping, laundry, cleaning) when this is the only care you need

  • Meal delivery

That should cover everything! Thanks for reading, and have a fantastic day!

bottom of page