Who pays for Home Health?

    The certified care managers at CVHC work with families to determine eligibility for Medicare and supplemental insurance benefits available for home healthcare. Sometimes a portion of home care is covered by insurance for a specific period of time, based on the patient's condition. Healthcare Concierge provides private pay services to continue home care after home health coverage stops.

    Home health is covered under the Parts A & B Medicare benefit. It consists of part-time, medically necessary skilled care (nursing, physical therapy, occupational therapy, and speech/language therapy) that is ordered by a physician.

    Medicare Home Health Eligibility

    Medicare enrollees are eligible for their home health benefits if they meet all of the following conditions:

    1. The physician must decide the patient needs medical care at home and make a plan for this care.
    2. A patient must need one or more of the following services:

      • Intermittent skilled nursing care
      • Physical therapy
      • Speech-language pathology services
      • Continued occupational therapy

    3. The patient must be homebound or normally unable to leave 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 absences for nonmedical
      reasons, such as a trip to attend religious services. Patients can still receive home health care if they attend adult day care.
    4. Eligibility is also based on the amount of services needed by the patient.
    5. The home health agency caring for the patient must be approved by the Medicare Program (“Medicare-certified”).

    If patients meet the conditions above, Medicare pays for their covered home health services for as long as they are eligible and their doctors say they are needed. Skilled nursing care and home health aide services are covered only on a part-time or “intermittent” basis. As a result, there are limits on the number of hours per day or days per week that patients can receive skilled nursing or home health aide services.

    When patients reach the limits of Medicare-covered home healthcare, home visits can be continued with private-pay or self-pay services.