Patient Resources

• Doctor’s orders are needed to start care. Once your doctor refers you for home health services, the home health agency will schedule an appointment and come to your home to talk to you about your needs and ask you some questions about your health.
• The home health agency staff will also talk to your doctor about your care and keep your doctor updated about your progress.
• It’s important that home health staff see you as often as the doctor ordered.

Examples of what the home health staff should do:

• Check what you’re eating and drinking.
• Check your blood pressure, temperature, heart rate, and breathing.
• Check that you’re taking your prescription and other drugs and any treatments correctly.
• Ask if you’re having pain.
• Check your safety in the home.
• Teach you about your care so you can take care of yourself.
• Coordinate your care. This means they must communicate regularly with you, your doctor, and anyone else who gives you care.

Medicare, Medicaid and most private insurance will cover eligible home health services like these:

• Part-Time Or “Intermittent” Skilled Nursing Care
• Physical therapy
• Occupational therapy
• Speech-language pathology services
• Medical social services
• Part-time or intermittent home health aide services (personal hands-on care)

Usually, a home health care agency coordinates the services your doctor orders for you.
Medicare and most insurance doesn’t pay for:

• 24-hour-a-day care at home
• Meals delivered to your home
• Homemaker services (like shopping, cleaning, and laundry), when this is the only care you need
• Custodial or personal care (like bathing, dressing, or using the bathroom), when this is the only care you need

All people with Medicare, Medicaid and most Private Insurance who meet all of these conditions are covered:

• You must be under the care of a doctor, and you must be getting services under a plan of care created and reviewed regularly by a doctor.
• You must need, and a doctor must certify that you need, one or more of these:
  -Intermittent skilled nursing care (other than drawing blood)
  -Physical therapy, speech-language pathology, or continued occupational therapy services. These services are covered only when the services are specific, safe and an effective treatment for your condition. The amount, frequency and time period of the services needs to be reasonable, and they need to be complex or only qualified therapists can do them safely and effectively. To be eligible, either: 1) your condition must be expected to improve in a reasonable and generally predictable period of time, or 2) you need a skilled therapist to safely and effectively make a maintenance program for your condition, or 3) you need a skilled therapist to safely and effectively do maintenance therapy for your condition. The home health agency caring for you is approved by Medicare (Medicare certified).
• You must be homebound, and a doctor must certify that you’re homebound
• You’re not eligible for the home health benefit if you need more than part-time or “intermittent” skilled nursing care
• You may leave home for medical treatment or short, infrequent absences for non-medical reasons, like attending religious services. You can still get home health care if you attend adult day care.

Before you start getting your home health care, the home health agency should tell you how much Medicare will pay. The agency should also tell you if any items or services they give you aren’t covered by Medicare, and how much you’ll have to pay for them. This should be explained by both talking with you and in writing. The home health agency should give you a notice called the Advance Beneficiary Notice” (ABN) before giving you services and supplies that Medicare doesn’t cover.

Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. Ask questions so you understand why your doctor is recommending certain services and whether Medicare will pay for them.