Who Qualifies For Home Health Care?

Home health care refers to any form of medical treatment provided directly in the comfort and convenience of your own home after hospital stays, surgeries or illnesses. Medicare-approved home health agencies typically offer skilled nursing care, physical therapy services, speech-language pathology support and more – the majority of these will typically be covered by Medicare while specific equipment you need at home such as wheelchairs and walkers may also be covered under their policies.

If you are receiving home health care, your physician must establish a plan and goals tailored specifically to you. This will determine what services are covered and when. Furthermore, they will decide whether you require the assistance of a home health aide or nurse; they can assist with daily tasks like bathing and cooking while monitoring blood pressure, temperature and heart rate on an ongoing basis.

Formerly, getting home healthcare could be challenging for some individuals; but, since the COVID-19 pandemic began, more seniors are accessing home health services than ever. Partly due to ease of finding and applying for services. Furthermore, changes to Medicare coverage has facilitated this trend as well.

As part of the COVID-19 pandemic, you can find more information on home health care by consulting the Centers for Medicare & Medicaid Services’ free online guide. It provides details on who qualifies, which services are covered, selecting an agency and understanding your rights as a patient.

Center for Medicare Advocacy recently issued a report showing that in 2023 many beneficiaries have been told that they do not qualify for home health care because their needs do not fit Medicare’s definition of being “homebound,” when in reality this is untrue – Medicare must cover home health care if your doctor believes it will improve your condition or enable you to remain safely at home.

Medicare covers some home health services, including home health aides and nurses, provided in New York through Personal Care Services (PCS). This article details eligibility requirements for PCS eligibility within Medicare Advantage plans and traditional Medicare, but this information also applies to individuals receiving PCS through fee-for-service Medicaid or managed care plans like Managed Long Term Care (MLTC) plans or NYS Choices programs.

Before your home health agency begins providing services, they must inform you how much Medicare will cover and provide an Advance Beneficiary Notice or “ABN.” They should also explain any services or supplies they feel Medicare will not cover both orally and in writing.

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