Did you know that according to the National Institutes of Health, some of the most common medical conditions requiring home healthcare are cardiovascular diseases, diabetes, chronic obstructive pulmonary disease (COPD), and Alzheimer’s disease? Home healthcare services can address a variety of medical needs, including medication management, wound care, providing medical equipment, medical social work services, and access to therapies such as physical, occupational, and speech-language therapy. (National Institute on Aging).
Qualifying for Skilled Home Healthcare Services
Skilled home healthcare is available to an individual who requires intermittent skilled medical services, but in order for it to be covered by Medicare, the person must be deemed “homebound.” Eligibility can depend on the individual’s insurance coverage, such as Medicare, Medicaid, or private insurance. Each insurance provider may have specific criteria that must be met for coverage. However, in general, individuals who may be eligible to receive Home healthcare services include:
- Physician’s Order: A physician’s recommendation or prescription for skilled home healthcare services is typically required for eligibility.
- Older Adults with Medical Needs: Individuals who have medical needs that require skilled nursing care, physical therapy, occupational therapy, or speech therapy may be eligible for home healthcare services.
- Homebound Individuals: Those who are considered homebound, meaning they have difficulty leaving their home without assistance due to their medical condition, may be eligible for home healthcare.
- Specific Medical Conditions: Some skilled home healthcare services are provided based on specific medical conditions or needs, such as wound care, infusion therapy, or post-surgical care.
Home Healthcare Eligibility with Medicare Coverage
In the United States, the majority (86%) of individuals receiving skilled home healthcare services are aged 65 and older. Medicare is the largest payer for home healthcare services, covering approximately 42% of all home visits. (Market.us Media)
If you have Medicare, you can get skilled home healthcare benefits if you meet all the following conditions:
- Your doctor must decide that 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, or physical therapy or speech-language therapy, or continue to need occupational therapy,
- You must be homebound, or normally unable to leave home unassisted. To be homebound means that leaving home takes considerable and taxing effort. A person may leave home for medical treatment or short, infrequent absences for non-medical reasons, such as a trip to the barber or to attend religious services.
- The home health agency caring for you must be approved by the Medicare program (Medicare-certified).
Click here to learn more about paying for skilled home healthcare. It’s important to check with the specific home healthcare provider or insurance plan to determine eligibility and coverage options.
If you are interested in learning more about how Boost Home Healthcare can support your care needs, please contact us.
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