Medicare covers a variety of heath care services that you can receive in the comfort and privacy of your home. These include intermittent skilled nursing care, physical therapy, speech-language pathology services and occupational therapy.
To be eligible for home health benefits you must be under a doctor’s care and receive your services under a plan of care established and reviewed regularly by a physician.
You must be homebound and have a doctor’s certification to that effect (being homebound means leaving your home isn’t recommended because of your condition, or your condition keeps you from leaving without using a wheelchair or walker, or getting help from another person).
Also, you must get your services from a home health agency that’s Medicare-approved.
If you meet these criteria, Medicare pays 100 percent.
For durable medical equipment (like a walker, wheelchair or oxygen equipment), you pay 20 percent of the Medicare-approved amount, after you pay the Part B deductible ($147 in 2013).
Skilled nursing services are covered when they’re given on a part-time or intermittent basis. In order for Medicare to cover such care, it must be necessary and ordered by your doctor for your specific condition. Medicare does not cover full-time nursing care.
Skilled nursing services are given by either a registered nurse or a licensed practical nurse under an RN’s supervision. Examples include: giving IV drugs, shots or tube feedings; changing dressings; and teaching about prescription drugs or diabetes care.
Physical therapy, occupational therapy and speech-language pathology services have to be specific, safe and effective treatments for your condition.
Before your home health care begins, the home health agency should tell you how much of your bill Medicare will pay. This should be both a verbal and written explanation.
For more details on Medicare’s home health benefit, please read our booklet, Medicare and Home Health Care. It’s online at www.medicare.gov/publications/pubs/pdf/10969.pdf.