For people 65 and older, the federal government's Medicare program is the primary form of health care insurance. Medicare provides various benefits for hospital and doctor services, as well as benefits for in-home health care. To qualify for in-home health care, you must require some level of skilled nursing care and receive your care through a Medicare-certified in-home health care agency.
Qualifying for In-Home Health Care
The Medicare in-home health care benefit is available if you meet four criteria. First, your doctor prescribes a plan a care that includes medical care at home. Second, your plan of care must include skilled nursing care on a part-time or intermittent basis. Third, you are homebound in such a way that it takes considerable effort to leave your home--that is you use a wheelchair, walker or need the assistance of another person. And, fourth, the in-home health agency used to deliver the services required by the plan of care must be Medicare-certified.
Types of Services Available
When you need skilled nursing care, Medicare in-home health benefits also include services for physical therapy, speech language therapy, occupational therapy and medical social services necessary to evaluate social and emotional factors related to your illness. Even home health aide services---that is, help with personal hygiene and dressing---that are not generally paid for by Medicare will be covered when you are also receiving skilled nursing care. Medical supplies covered include such things as wound dressings, walkers and wheelchairs. In some cases Food and Drug Administration-approved osteoporosis drugs are also covered.
Plan of Care
The plan of care for in-home health care prescribed by your doctor will be done in coordination with a home health care nurse and specify the services you need, the health care professional who should provide the services and the schedule for providing the services. Any necessary medical equipment will also be specified. A home health care agency will be chosen to implement the plan. Medicare requires that at least every 62 days your doctor and home health care agency review your plan to monitor your progress toward the results your doctor expects from the care. If your condition is severe, the review should be done more frequently.
Length of Services
Your Medicare benefits for in-home health care are available for as long as the plan of care prescribed by your doctor is medically reasonable and necessary, although there are limits regarding the amount of services you can receive per week. Because the Medicare benefit is only for part-time or intermittent care the limits are as follows: for intermittent care, any skilled nursing care must be required for less than seven days a week or eight hours per day over a 21-day period. For part-time care, the weekly maximum ranges from 28 to 35 hours---depending on the severity of your condition---and the services provided must be performed in eight hours or less per day.
Choosing Agency
Although your doctor and a home health care nurse or other medical planner can arrange your in-home health care, you have the right to choose which home health care agency will provide your services. The only limitation is that the agency be Medicare-certified.
