Medicare is the federal health insurance program that provides basic health care services for seniors over the age of 65. It consists of four basic parts: Part A covers hospital services; Part B covers physician charges and lab fees; Part C, or Medicare Advantage, allows enrollees to access care through a system of private managed care organizations; and Part D is a prescription drug plan. Medicare does, on occasion, provide for home health care, but only under specific and limited circumstances.
Medicare Eligibility
To qualify for Medicare, you must be over age 65 or older, or fall into another statutorily eligible category. These include individuals with end stage renal disease, and those with amyotrophic lateral sclerosis, or Lou Gehrig's Disease.
Home Care Eligibility
To qualify for home health services under Medicare, you must be under a doctor's care, and your doctor must certify that the home care services are medically necessary, neccessitating intermittent skilled nursing care, occupational therapy, speech or language therapy or physical therapy.
Homebound
Your doctor must also certify that you are homebound. You are considered homebound if leaving your home is impossible, would aggravate your medical condition, you cannot leave home without assistance from another person, or without a walker or cane or leaving home would require such extraordinary exertion as to be impractical.
Frequency of Care
For Medicare to authorize home health care, the need must be intermittent, not constant and chronic. If you need constant skilled nursing care or daily therapy, Medicare will typically not approve home health care, since services under those circumstances can be much more efficiently delivered in an institution. For Medicare purposes, "intermittent" means needed for fewer than seven days each week, for less than eight hours per day, unless the need is temporary, with a prognosis for improvement.
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