Frequently Asked Questions

Q: Who can receive home health care under their Medicare benefits?
A: Medicare has established criteria that individuals must meet to be able to use their Medicare benefits:

• Patient must be homebound
• Patient must be under the care of a physician who establishes and periodically reviews the plan of care
• Care must be intermittent
• Care must be provided by a skilled health care individual such as a Nurse or Physical Therapists
• Care must be provided in their place of residence
• Care must be medically reasonable and necessary

Q: What does homebound mean?
A: Homebound means that it takes the patient considerable and taxing effort to leave their place of residence. Absences must be infrequent and of short duration. Individuals may attend religious services and occasionally get their hair done. Someone may be homebound for a short time. After a hospitalization most individuals are home for a few weeks recuperating. They don't feel like they have the energy to go out. They would be considered homebound during that recovery time. Patients do not decide if they are homebound. Their condition and ability determine this status. You can be homebound while staying in someone else's home as long as it takes considerable and taxing effort for you to leave their home.

Q: Who can establish/oversee a Plan of Care?
A: MDs, DOs or Podiatrists may establish the Medicare Plan of Care. A Nurse Practitioner or Physician's Assistance may not oversee a Medicare Plan of Care or order home health care to start.

Q: What is considered intermittent care?
A: Care, whether by a nurse or therapist, cannot be provided on a daily basis except under limited and very specific circumstances. Short duration of daily visit is permitted such as daily for a weekly. This may be needed when caregivers are learning new skills such as wound care or insulin injections.

Q: What is considered a patient's place of residence?
A: The place of residence may not be a hospital, skilled nursing facility, or intermediate care facility. It may be a group living situation such as an Assisted Living Facility but services the facility provides may not be duplicated by home health care.

Q: What does reasonably and necessary mean?
A: According to Medicare, this means appropriate to the patient's symptoms and in accordance with acceptable standards of care. It cannot be provided for comfort or for custodial reasons. Many times patients will need home health care after being diagnosed with a new disease, when a pre-existing disease changes, or with a new caregiver.

Q: If I receive home health care under my Medicare benefits, how much will it cost me?
A: At the current time, there is no co-pay or cost for Medicare home health care.

Q: What is the physician face to face requirement?
A: Medicare now requires the physician, who will be signing the Plan of Care, to see and examine the patient 90 days prior to the start of home health care or 30 days after home health care has been started. The doctor must then provide the home health care agency with documentation of the care he/she feels is appropriate and the reason the patient is homebound. If the physician is not willing to provide this documentation, the patient will not receive home health care.

Q: Is a visit by a nurse to determine patient needs covered by Medicare?
A: No, these are called "evaluation" visits and they are not covered under Medicare benefits.

Q: What about DME (Durable Medical Equipment) and medical supplies?
A: Payment for DME, such as wheelchair, walkers, or mechanical lifts, is not part of the home health care plan of care. The home health care nurse or therapist will help the patient obtain needed prescriptions from the physician. It is then the patient's/caregiver's responsibility to obtain the equipment. Medical supplies, such as wound care supplies or ostomy supplies are covered under the homecare plan of care. Home health care agencies are not required to furnish patients with specific name-brand supplies but must provide them with a comparable alternative.

Q: Can a nurse come and pre-fill my medication box or get blood samples if my doctor orders those things?
A: Yes and no. If you are receiving home health care for other reasons, then those things can be done. If those are the only things your physician wants the nurse to do, then Medicare will not reimburse the home health care agency for those visits. You may contract with a home health care company privately to do those things.

Q: What if I'm not feeling well and I just want a nurse to come out and check me, will Medicare pay for that?
A: Not usually. The home health care agency will inquire to determine if you meet the criteria to receive care under your Medicare. If you do not, you may contract with a home health care company privately for that care.

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