Approximately eighty percent of all home health visits are paid by Medicare. The Medicare program covers the elderly (those 65 and over) and individuals who have been disabled for two or more years. Medicare has the most restrictive requirements for payment of home health services. However, it is frequently the only resource the elderly have for needed care.
Medicare is a federal program that has two parts - Part A and Part B. All
home health services can be covered under either Part
A or Part B while other forms of health care are only covered under one of the parts. For example, hospitals and short term nursing home care are covered only under Part A, while doctor's visits, durable medical equipment, ambulance and outpatient services are covered under Part B.
Medicare is not an entitlement program, but rather an insurance program. As an insurance program, Medicare covers only certain situations and items that meet the program's criteria.
To be eligible for home health service under the Medicare program, the client must:
- Have a valid Medicare card or other evidence showing entitlement to Medicare benefits.
- Be essentially homebound (unable to leave home without a considerable taxing effort or able to leave home only for limited, essential medical appointments.)
- Be under a physician's plan of treatment that specifies Home Health Services.
- Require one or more of the primary services (nursing, physical therapy or speech therapy) on an intermittent basis.
- Have an unstable (changeable) medical condition that will respond to treatment in a "reasonable" period of time.
- Require services on a predictable basis of at least once per 60 days.
- 3HC -
2402 Wayne Memorial Drive
Goldsboro, NC 27534
919-735-1387
info@3hc.org
Home Health Services
