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Medicare Home Health Agency: How to Get Coverage for Home Health Care

Medicare home health agency: how to get coverage for home health care

Posted on May 15, 2023 by Larry Johnson

Wonder if Medicare helps pay for home health agency services? Call us today at (800) 950-0608 - our licensed agents may be able to help you find a plan that covers the services you need.

What’s the Link Between Medicare and Home Health Agencies?

As time goes on, more seniors find themselves needing the services of home health care agencies. If you’re a senior who prefers aging in place to living in a facility, the services of a home health care agency may become a necessity for you at some point.

In response to this, you may have several questions:

  • How do I find home health care agencies near me?
  • How can I find a quality home health care agency?
  • Is there a specific Medicare home health agency?
  • How can I find a Medicare certified home health agency?
  • What services do home health care agencies offer?

The broad answer to most of the questions above is “yes”. Medicare covers home health agency services, but only to a certain degree. In this article, we’ll provide more in-depth answers to these questions, and hopefully, we may be able to answer some others that you have about how Medicare works with local home health agencies.

how to find Medicare certified home health agencies

What is a Home Health Agency?

While many of you reading this article may have heard of home health agencies, there are some of you who haven’t. Home health agencies are health care agencies that provide healthcare services and treatments to individuals who are homebound. They do not cater strictly to seniors, but seniors make up most of a home health agency’s clientele.

Home health care agencies do not typically provide long-term care. Instead, they are designed to help you recover from serious illnesses or injuries, helping you return to a normal standard of life. If you require long-term care, but you prefer to age in place, you will need a caregiver.

If you’re in need of a home health care agency, but are unsure of how to find one in your area, many sites, including MedicareInsurance.com, offer or can help you find resources to get you the care that you need. One such resource is the Medicare Advantage Housecalls program, a program that allows you to have an annual wellness visit at home if you are unable to visit your Primary Care Physician.

You can also search for a Medicare certified home health agency that meets your needs by using the following phrases:

  • “Home health care agencies near me”
  • “Home health care agencies”
  • “Medicare home health care agencies”
  • “Medicare home health agency”
  • “Medicare certified home health care agencies near me”
  • “Medicare certified home health agency near me”

There is No Specific Medicare Home Health Agency

Those of you who may have been wondering if there’s a specific Medicare home health agency through which Medicare offers home health services. Medicare does not provide actual healthcare services. Instead, CMS certifies home health agencies to accept Medicare assignment based on whether or not they meet certain CMS standards.

If your doctor determines that it is difficult for you to leave your home, or you are unable to do so, they help you set up home health care services through a home health care agency. In order to have your home health care covered by Medicare, your doctor has to connect you to a Medicare certified home health agency. If the agency chosen does not accept Medicare assignment, then you will be required to pay for all home health services Out-of-Pocket.

will Medicare pay for home health agency care

The Scope of Medicare Coverage for Home Health Agency Services is Limited

Medicare will cover services and treatments provided by a Medicare certified home health agency. However, it will not cover every service that the agency provides.

In order to have Medicare cover services provided by home health agencies, you’ll need to meet the following criteria:

  • You must be enrolled in either Original Medicare or a qualified Medicare Advantage plan
  • You must be under the care of a doctor or other allowed practitioner
  • You must be receiving regular services under a care plan which has been created and is reviewed regularly by your doctor or practitioner
  • Your physician must certify that you need any of the following:
    • Intermittent skilled nursing care (blood draws not included)
    • Physical therapy
    • Speech-language pathology
    • Continuous occupational therapy
  • You must be homebound, and your doctor/practitioner must certify you as homebound

You cannot receive home health coverage through Medicare if you need more advanced care than you can receive through a home health care agency, or if you are not considered “homebound” as it pertains to the medical definition*. For instance, you cannot receive coverage for home health care if you’re able to leave the house for more than medical treatments or short, timely absences, such as adult day care or religious services.

Through Medicare, your cost is usually zero for services provided by a Medicare certified home health agency. Once you’ve met your Part B deductible, you’ll only pay 20 percent of the approved amount for covered medical equipment. Medicare insurance typically covers the following home health care services:

  • Medically necessary part-time nursing care
  • Medically necessary intermittent skilled nursing care
  • Physical therapy
  • Occupational therapy
  • Medical social services
  • Part-time home health aide care (only for patients who are also receiving skilled nursing care)
  • Durable medical equipment
  • Medical supplies for home use

*The medical definition of “homebound” refers to a person who: has trouble leaving home without mobility aids or assistance, has a condition where leaving home may be harmful to their health, or leaving their home requires a major effort that is taxing on the body.

I Receive Medicaid Benefits - Will They Also Pay for Home Health Care

Yes! If you are a Medicaid recipient, your benefits will cover the care you receive through Medicaid certified home health care agencies. Medicaid and home health agencies work together in much the same way as CMS and home health agencies.

In order for your benefits to cover your home health care, the home health agency you choose must be Medicaid certified. Medicaid and home health care agencies cannot work together to help cover your medical needs if the agency is not certified. To find Medicaid certified home health care agencies near you, conduct a search using the following terms:

  • “Medicaid home health care agencies”
  • “Medicaid certified home health care agencies”
will Medicaid pay for home health agency care

If You’re In Need of Home Health Care, Medicare Can Help

If you’re like other seniors out there, you may be nervous about seeking home health care for the fear that all of the costs will fall on you. In this day and age, though, it’s easier knowing which home health care agencies accept Medicare assignment and which ones do not.

Would you like to learn whether or not your Medicare coverage will help pay for the home health care that you need? Give us a call today! Our experienced licensed agents are always happy to answer any questions you may have.

About the Author

Larry Johnson

Larry Johnson

Larry is a content writer with several years of experience in creating informative content for a variety of industries on topics that matter. He is a 2009 graduate of the University of North Carolina School of the Arts.

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