Home health services offer medical care that can help improve our quality of life from the comfort of your own home. If you’re facing medical challenges and prefer assistance at home, understanding your eligibility for these services is the first step.
Eligibility is typically based on specific medical needs and guidelines set by insurance providers, like Medicare. Knowing who qualifies for home health care services can help you advocate for the best possible care and know your options.
What Are Home Health Care Services?
Home health care involves a wide range of medical services provided in your home for an illness or injury. It’s usually less expensive, more convenient, and just as effective as the care you get in a hospital or skilled nursing facility. The goal is treatment while helping the patient regain independence and become as self-sufficient as possible.
Common home health services include:
- Skilled nursing care (Monitor and educate on chronic conditions, wound care, and injections)
- Physical, occupational, and speech therapy
- Medical social services for counseling and resource connection
- Home health aide services for personal care assistance
Health Care vs. Non-Medical Care
It’s important to understand the difference between home health care and non-medical home care. Home health care is clinical, medical care prescribed by a doctor. Non-medical care, often called personal or companion care, helps with daily activities like cooking, cleaning, or running errands, and typically doesn’t require a doctor’s order for insurance coverage.
Qualifications To Look At
Who qualifies for home health care services? To receive home health services covered by Medicare or private insurance, there are generally four key requirements you need to meet.
1. Needing Skilled Medical Care
To qualify for home health care services, a patient must need skilled care. This means the care is complex enough to be safely and effectively performed only by, or under the supervision of, professionals like registered nurses or licensed therapists.
If the care needed is purely custodial (like help with bathing or dressing only), it usually does not qualify as skilled care on its own.
Examples
- Caring for surgical wounds
- Managing intravenous (IV) medications
- Needing physical therapy to restore movement after a stroke or fall
2. Being Considered Homebound
For many insurance plans, particularly Medicare, the patient must be considered homebound. You might qualify as homebound if you need the assistance of a supportive device (such as a cane, wheelchair, or walker) or another person to leave home, or if your doctor believes leaving home could worsen your condition.
Certain outings may still be allowed, such as medical appointments or short, infrequent non-medical events like a family graduation or religious service.
3. Doctor’s Referral and Care Plan
Even if you’re sure you qualify for home health care services, you can’t sign yourself up; a doctor, nurse practitioner, or other healthcare professional must order the service and certify that you’re under their care.
Once referred, the home health agency will work with your doctor to create a specific plan of care. This plan outlines what services you will receive, how often professionals will visit, and what goals you’re working toward.
4. Ongoing Recovery or Chronic Condition Management
Home health is often used for short-term recovery, but it can also be vital for managing chronic issues. You may qualify for home health care services if you’ve recently been discharged from a hospital or skilled nursing facility and need help transitioning back to daily life.
Alternatively, if you are managing a chronic illness like heart failure or diabetes, skilled nursing can teach you to manage your condition to prevent it from getting worse.
Insurance And Coverage Considerations
Medicare is the most common payer for home health services, but Medicaid and private insurance plans also offer coverage. Medicare typically covers 100% of eligible home health services if all qualifications are met. However, we recommend that you verify your specific benefits, as private insurance plans may have different copays or requirements.
How To Find Out If You Qualify
If you believe you know someone who qualifies for home health care services, take the next step! Here’s how to get started:
- Talk to your doctor. Ask your primary care physician if home health services are right for your specific medical situation.
- Schedule an assessment. A home health agency can evaluate your specific needs and eligibility.
Let the HealthView Family Care For Yours
If you’re worried about eligibility or need help with the referral process, HealthView Home Healthcare Services is here to help with compassion and expertise. Our team is always available to answer your questions and guide you toward the right care plan. Contact us today to take the next step.