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Frequently Asked Questions



What Medicare Covers

Medicare will help cover home health care costs for people with Medicare who meet the following four conditions:

• Your doctor must decide you need medical care at home and make a plan for your care at home.

• You must need at least one of the following: intermittent skilled nursing care, physical therapy, speech-language therapy, or continue to need occupational therapy.

• You must be homebound. This means that you are normally unable to leave home unassisted. Being homebound means that leaving is a major effort. When you leave home, it must be to get medical care, or for short, infrequent, non-medical reasons such as a trip to get a haircut, to attend religious services, or adult day care.

• The Medicare program must approve the home health agency caring for you.


What Is Skilled Home Health Care?

You may have heard the term “home care” used to describe a variety of services, from wound treatment to meal and laundry service. Skilled home
health care, however, is very specific, and usually prescribed by a physician. Skilled home health care patients require the services of a licensed health care professional such as a medical doctor, nurse or therapist. The services can be for either a short or long period of time. Perhaps most important, home health care services are usually eligible for Medicare/Medicaid or other private insurance payment if certain requirements are met.


Who Decides If I Need Skilled Home Health Care?

Usually, your physician will decide if this care is right for you. If so, he or she will develop a “plan of care” that describes your health needs and what care or treatments we can provide for you. This care plan is an important part of the quality of care we provide. It ensures that you and your family understand exactly what we plan to do for you and your role in getting better.


Who Pays For Skilled Home Health Care Services?

Medicare, Medicaid and managed care/insurance plans cover many of the health care services provided in the home. Medicare, and in some states, Medicaid, will not pay for personal care services, such as personal aides, unless skilled nursing services or physical therapy is also provided.


Who Coordinates My Care Plan?

Generally, a home health registered nurse or therapist will coordinate your plan of care under the direction of your doctor. His or her job is to make sure you are informed and educated about your condition in addition to providing services such as intravenous drug administration, medication management, wound care or post surgical rehabilitation. Specialists, just like in the hospital, may provide very specific services. It is your unique plan of care that defines which of the specialists and other home health care staff will be needed to provide you with the necessary treatment or services.