Home Health Care & Medicare -
A Consumer's Guide to Coverage

How does a patient qualify for Home Care?
All five of these Medicare conditions must be met:

1. You must be a Medicare beneficiary.
2. Your physician decides that you need care in your home and sets up a plan of care to meet your needs.
3. The care you need is intermittent (not full-time or private duty) skilled nursing, physical therapy or speech-language pathology services.
4. You must be homebound. This means that you can only leave home with considerable and taxing effort. Your absences from home are infrequent, or of short duration or to get medical care. You still can be considered homebound if you occasionally go to the barber or beauty shop. You cannot drive your own car and be considered homebound.
5. Your home health agency must be certified as a Medicare provider.

What does Medicare pay for?
Medicare covers only medically reasonable and necessary home care services. These include:

• Skilled Nursing Care – such as wound care, injections, teaching and other care that cannot be performed safely and effectively by a nonmedical person.
• Home Health Aide Services – including assistance with personal care, exercises, vital signs and bed linen changes.
• Physical Therapy – provides treatment to restore movement and regain strength.
• Speech-Language Pathology – includes treatment to help speech and swallowing disorders.
• Occupational Therapy – provides treatment to improve activities of daily living, such as eating, dressing and other routine tasks.
• Medical Social Services – can assess the social, emotional and financial factors relating to your illness and provide access to community resources.
• Medical Supplies – such as wound dressings and braces are covered; personal care items are not.
• Medical Equipment – such as wheelchairs, walkers and oxygen equipment. Medicare pays 80 percent of the approved amount of the equipment. You are responsible for the remaining 20 percent.

Southern Home Care does not provide medical equipment, but can help arrange for the equipment you need.

The services of skilled nurses, home health aides, social workers and therapists are fully paid by Medicare. Southern Home Care bills Medicare directly.

What's Not Covered by Medicare?

• 24-hour or private duty nursing at home
• Prescription drugs
• Meals delivered to home
• Homemaker services such as shopping, house cleaning or laundry
• Personal care by home health aides, if this is the only care you need

How is my care planned and directed?
With the help of your home care nurse, you and your physician develop a plan of care. Together you will decide what kind of services you need, how often you need them and who should provide them.

Your plan of care includes such things as the kind of skilled care you need, medical equipment, the results your physician expects from home care, medications and even your diet.

You, your home care staff and your physician review your plan of care as often as necessary, but at least every 60 days. Your home care staff will contact your physician about changes in your condition that need attention.

How long will services continue?
Generally speaking, Medicare will pay for covered services for as long as they are considered medically reasonable and necessary. However, there are limits on the number of days and hours of care you can receive in a week.

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