The Star Democrat

Medicare covers some home health care costs

- By MIKE ZIMMER

Home health care is a wide range of health care services that can be given in your home for an illness or injury. Home health care is usually less expensive, more convenient, and just as effective as care you get in a hospital or skilled nursing facility (SNF).

In general, the goal of home health care is to provide treatment for an illness or injury to help you get better, regain independen­ce and become as self-sufficient as possible. Home health care may also help you maintain your current condition or level of function or to slow down decline.

Medicare pays for you to get health services in your home if you meet certain eligibilit­y criteria and if the services are considered reasonable and necessary for the treatment of your illness or injury.

Who’s eligible?

If you have Medicare, you can use your home health benefits if:

1. You’re under the care of a doctor, and you’re getting services under a plan of care establishe­d and reviewed regularly by a doctor.

2. You need, and a doctor certifies that you need, one or more of the following:

• Intermitte­nt skilled nursing care (other than drawing blood)

• Physical Therapy • Speech-Language Pathology Services

• Continued Occupation­al Therapy

• Home Health Aide Services (only if you are receiving Skilled Care)

• Medical Social Services • Medical Supplies such as wound dressings when your doctor orders them as part of your care

3. The home health agency caring for you is approved by Medicare.

4. A doctor certifies that you are homebound. To be homebound means:

• You have trouble leaving your home without help (like using a cane, wheelchair, walker, or crutches; special transporta­tion; or help from another person) because of an illness or injury, or leaving your home isn’t recommende­d because of your condition.

• You are normally unable to leave your home, but if you do it requires major effort.

You may leave home for medical treatment or short, infrequent absences for non-medical reasons, like an occasional trip to the barber, a walk around the block or a drive, or attendance at a family reunion, funeral, graduation, or other infrequent or unique event. You can still get home health care if you attend adult day care or religious services.

5. As part of your certificat­ion of eligibilit­y, a doctor, or certain health care profession­als who work with a doctor such as a nurse practition­er, must document that they have had a face-to-face visit with you within required time frames and the visit was related to the reason you need home health care.

If you only need skilled nursing care, but you need more than “intermitte­nt” skilled nursing care, you don’t qualify for home health services. To determine if you are eligible for home health care based on a medically predictabl­e recurring need for skilled nursing, Medicare defines “intermitte­nt” as skilled nursing care that is needed or given either:

• Fewer than 7 days a week.

• Daily for less than 8 hours each day for up to 21 days. Medicare may extend the three-week limit in exceptiona­l circumstan­ces if your doctor can predict when your need for daily skilled nursing care will end.

If you are expected to need full-time skilled nursing care over an extended period of time, you would not qualify for home health benefits.

Mike Zimmer is president of Bay State Insurance Agency Ltd in Centrevill­e. He is available to answer questions regarding Retirement Planning, Medicare, Medicare Supplement­s, Medicare Part D (Prescripti­on Plans), Dental and Vision Plans. He may be reached at 410-7581680. For updates and more informatio­n, visit and like the Facebook page Bay State Insurance Agency, LTD.

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