Medicare Guidelines Used to Establish Coverage for Home Care

The following items are required for Medicare to pay for your home care services:

  • You must be homebound. Medicare states that due to your illness or injury, it takes a considerable taxing effort for you to leave your home. When absent, you are away infrequently and for a short duration. You are still considered homebound if you leave to attend medical appointments . Unique or infrequent events such as attending religious services, family reunions, funerals and graduations are also permissible. If you drive or get out of the house on a regular basis to shop, eat or spend time with friends, you probably do not meet the homebound requirement.
     
  • You must have a recent illness, worsening condition or injury that requires the skilled services of a professional nurse, physical therapist, occupational therapist or speech therapist.
     
  • You must be an eligible Medicare beneficiary and under the care of a physician that ordered the treatment or services that we provide. If services are not deemed reasonable, medically necessary or ordered by your doctor, Medicare will not cover the costs.
     
  • Care must be provided on at least an intermittent basis. Medicare will not pay for home care staff to stay with you for an extended period of time. We will only visit you for the length of time needed to provide the specific treatment ordered by the physician.
     

If all of these requirements are met, Medicare will pay for medically necessary Skilled Nurses, Physical Therapists, Occupational Therapists, Speech Therapists, Medical Social Services, Home Health Aides and covered medical supplies.

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