Choosing an Agency Apple Valley Inland Empire St Bernardine Care ProvidersIf your doctor decides you need home health care, you have the right to choose which home health agency will provide you with the care and services you need. It is important to remember that Medicare only pays for skilled home health services that are provided by a Medicare certified agency, which is an agency that meets certain quality standards set by the Medicare program.

Although, you have a say in which home health agency you use, your choices may be limited by agency availability or if you are in a Medicare Managed Care health plan, you may have to use the home health agency that works for the health plan. A home health agency has the right to refuse to accept any individual patient if the agency is unable to meet the patient’s needs.

You can find a Medicare-approved home health agency by:

  • Looking at “Home Health Compare” at www.medicare.gov on the web.
  • Asking your doctor, hospital discharge planner, social worker or friends who have had home care experiences
  • Using a senior community referral service or other community agencies that help you with home health care
  • Looking in your telephone directory in the Yellow Pages under “home care” or “home health care”. (Look for home health agencies that are Medicare approved.)

Who is eligible to receive Medicare-covered Home health care?

If you have Medicare you can use your home health care benefit if you meet all of the following conditions:

  • Your doctor must order the home health care you are to receive
  • You must need 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 your 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 non-medical absences such as a religious service or a trip to the barber.
  • The home health agency must be Medicare-certified.

How long does Medicare cover home health services?

Medicare covers your home health services for as long as you are eligible and your doctor says you need these services. The skilled nursing care and home health aide services are only covered on an intermittent or part-time basis. Medicare defines intermittent as skilled nursing care needed or given on fewer than 7 days each week or less than eight hours per day over a period of 21 days (or less) with some exceptions in special circumstances.

What home health services does Medicare pay for?

If you are eligible for home health care Medicare will cover:

  • Skilled nursing care on a part-time or intermittent basis. Skilled nursing care includes services and care that can only be performed safely and correctly by a licensed nurse (either a registered nurse or a licensed practical nurse).
  • Home health aide services on a part-time or intermittent basis. A home health aide does not have a nursing license but provides services that give additional support to the nurse. Examples are helping with personal care such as bathing, using the toilet or dressing. Medicare does not pay for home health aide services unless you are getting skilled services such as therapy or nursing care.
  • Physical therapy, speech-language therapy and occupational therapy for as long as your doctor says you need it.
  • Medical social services to help you with social, emotional and financial concerns related to your illness.
  • Certain medical supplies like wound dressings, but not prescription drugs.
  • Medical equipment such as a wheelchair or walker when ordered by your doctor.

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