:: ELIGIBILITY CAN BE DIFFICULT TO DETERMINE
Eligibility can be difficult to determine, but the best way to find out is to give us a call. Speaking directly to one of our representatives will give us an opportunity to customize an approach best suited for you and your family.
In the meantime, the following information may help you make a decision.
Under Medicare requirements the following criteria must be me in order to be eligible for Home Health care:
- A normal inability exists to leave home and, consequently, leaving home would require a considerable and taxing effort.
- If the patient leaves home, the absences from the home are infrequent or for periods of relatively short duration, or are attributable to the need to receive health care treatment.
- The patient has a condition due to an illness or injury that restricts ability to leave their place of residence except with the aid of supportive devices such as crutches, canes, wheelchairs, and walkers, the use of special transportation, or the assistance of another person or if leaving home is medically contraindicated.
Essentially, patients must be "homebound" but that word means different things to different people. In most cases leaving home is a major effort, you are normally unable to leave home unassisted, or if you leave home, it must be to get medical care, or for short, infrequent non-medical reasons such as a trip to get a haircut, or to attend religious services or adult day care. The patient can still socialize but there are rules regarding how the patient gets to the social event! If the patient has private insurance other than Medicare, those rules don’t necessarily apply.
If you are covered by Medicare Part A
To receive home health aide services with 100% coverage, the patient must be homebound, have orders from a physician, and need treatment requiring a skill such as nursing or specialized therapies.
If you are covered by Medicare Part B
Medicare will pay 80% with a 20% co-pay and an order from the physician, a need for a specialized therapy (physical, occupational, speech), and the ability to have therapies performed in the home. Note that under this plan, nursing or home health aide is not covered.
:: PRIVATE DUTY
Services include personal care such as bathing and meal preparation, sitters, or light housekeeping. Patients cover the costs of nursing, physical, speech, and occupational therapies.
Navigating the nuances of coverage and care can be complicated at a time when you are feeling anxious and concerned. Please call us. We do our best to make the information straight forward and applicable to the patient and family. We will be happy to talk with you about eligibility and many other important issues surrounding good care. We look forward to hearing from you.
:: SOURCE OF PAYMENT
- MEDICARE
- MEDICAID/PUBLIC AID
- PRIVATE INSURANCE
Consider the most Dependable Nursing Home Health Care when considering your loved ones!





