Home Health Eligibility Requirements
While each insurance has their own criteria for how you can qualify for home health services, most plans (including Medicare, Medicare Advantage, and Medicaid plans) have a few common requirements:
1
Physician Orders
Home health care is offered under the direction of a physician (including a doctor, nurse practitioner, or physician assistant). Therefore, your physician needs to be willing to sign orders and oversee your care.
2
Need for Skilled Services
Home health care must be skilled. This means that while you might need someone to help with your activities of daily living (getting dressed, bathing, going to the bathroom, etc.), you also need the care of a nurse or physical, occupational, or speech-language therapist.
3
Homebound
You must be mostly unable to leave your home. This doesn't mean you can never leave, but it does mean that it takes a significant effort to leave your home.
4
Intermittent
Your care should be intermittent, meaning that you don't need full-time care. If your care needs are more intense, it may be better to receive care in a Skilled Nursing Facility before transitioning to home health.
5
Cooperation
It can be frustrating at times to be limited, but our clinicians are looking out for you! We request that you cooperate with them and heed their instructions. As you do so, you will be able to return to full health more quickly than if you choose not to work with them.
How is my home health care paid for?
Medicare Part A or Part B: For those who are on traditional Medicare, Medicare pays 100% for all home health services under Part A or Part B coverage. This means that you will never get a bill for your services from us.
Medicare Advantage: Most Medicare Advantage plans pay 100% for home health services. This payment is subject to authorization and network requirements
Private insurance, including employer, auto, and worker's compensation: These plans vary and may or may not include a copay, out of pocket maximum, or deductible. They are also subject to insurance network rules. For a list of providers we are in network with
Medicaid: Medicaid services are always covered at 100% and you will never receive a bill for your services from us.
If you still have questions or need assistance determining if your insurance will cover home health care, reach out to First Choice Home Health & Hospice today! Our team of caring professionals will help you determine if you qualify and what you may expect to pay.
