Do I qualify for Home Health Care Services?
One may qualify for home health care services through one or more of the following options:
Recipients of Medicare may qualify for home health care benefits meeting the following criteria:
All persons with Part A and/or Part B who meet all of these conditions are covered:
- You must be under the care of a doctor, and you must be getting services under a plan of care created and reviewed regularly by a doctor.
- You must need, and a doctor must certify that you need, one or more of these:
- Intermittent skilled nursing care (other than drawing blood)
- Physical therapy, speech-language pathology, or continued occupational therapy services. These services are covered only when the services are specific, safe and an effective treatment for your condition. The amount, frequency and time period of the services needs to be reasonable, and they need to be complex or only qualified therapists can do them safely and effectively.
- To be eligible, either: 1) your condition must be expected to improve in a reasonable and generally predictable period of time, or 2) you need a skilled therapist to safely and effectively make a maintenance program for your condition, or 3) you need a skilled therapist to safely and effectively do maintenance therapy for your condition. The home health agency caring for you is approved by Medicare (Medicare certified).
- You must be homebound, and a doctor must certify that you’re homebound.
For more information go to www.medicare.gov
*****To be considered “homebound” by Medicare you must need the help of another person or medical equipment such as crutches, a walker, or a wheelchair to leave your home, or your doctor believes that your health or illness could get worse if you leave your home.*****
If you are currently receiving Medicaid and your doctor determines that you have a medical condition that in result causes you to need assistance with everyday living activities such as bathing, getting dressed, doing routine hair and skin care, preparing meals and eating, getting exercise, using the toilet, walking, and getting in or out of a bed etc., then you may be eligible for PHC (primary home care). Primary Home Care is a Texas program that will provide long-term care services at home.
Short Term Care
Medicaid will cover short term home health care services for acute conditions following a hospital stay or if leaving a skilled nursing or rehabilitation facility. Since Medicaid funded home health care services are provided based on the plan of care prescribed by a doctor for certain medical conditions expected to improve, the state will reevaluate your need for care every 60 days.(hints: short term care)
Additionally, Medicaid will only pay for in-home care if provided by a Medicaid-certified home care agency, NOT by an independent paid caregiver or family member. For more information go to https://hhs.texas.gov/
Long Term Care Insurance
Long term care insurance plans are typically obtained by persons around 60 years of age. They help to cover costs if you have a medical condition, mental disorder or disability. For example an individual who has Alzheimer’s disease would be able to use their long-term care insurance to cover the cost of home health care services. If you have a medical condition and you believe that you may be in need of home care services contact your insurance provider to find out if you are covered.
Some people prefer to use their own financial resources and pay the out of pocket cost for certain services provided to them. They may look into their own savings, home equity, retirement funds or they look to family members to assist in covering the cost. In general most home health care companies will work with you to make a payment arrangement for their services. Speak with family and financial advisors to make the best financial decision if you are thinking of paying out of pocket for care.
If you or your family member have served in the military they may qualify for VA benefits. You must meet certain criteria to become eligible for home health care benefits such as disability status, other insurance coverage, need for treatment, income level, need for assistance and personal care. For more information visit www.va.gov/healthbenefits/apply/veterans.asp
There may be other sources that will make you eligible for home health care such as being involved in an auto accident or if you have sustained a work related injury then you may look into workers comp or insurance companies involved in the accident.
If you are interested in receiving home health care services and believe you may qualify but unsure if you are covered under your insurance plan, or you just have questions about services please give us a call at 972-602-3500. Newport Home Health currently accepts Traditional Medicaid/Medicare, Amerigroup, Molina and Superior Health. Our office staff will be more than happy to assist you in finding out if you qualify and getting you the help you need.