Medicare and insurance
Medicare and insurance coverage for home health care
Most patients who qualify for skilled home health pay nothing out of pocket under Original Medicare. Here's how coverage works, and how we verify it for you.
Who qualifies for Medicare home health
Original Medicare Part A and Part B cover home health care when a few conditions are met. You must be under the care of a doctor with a plan of care, need intermittent skilled nursing or therapy, be certified homebound, and receive care from a Medicare-certified home health agency. Medicare also requires a face-to-face visit with a doctor or allowed practitioner related to the reason for home care.
When those conditions are met, Medicare pays for covered home health services with no copay or deductible. Durable medical equipment such as a walker is typically covered at 80 percent after the Part B deductible. You can read Medicare's own explanation at Medicare.gov.
Ask our office about Violet's current Medicare and insurance participation for your plan. We check eligibility before the first visit so there are no surprises.
What we handle for you
Insurance is the part families dread most, so we take it on. Our office contacts the physician for orders, confirms the face-to-face requirement, and verifies benefits with Medicare, Medicare Advantage or your private plan.
If something isn't covered, we'll tell you plainly and talk through options before any care is scheduled.
FAQ
Coverage questions
What does homebound mean?
Under Medicare rules, leaving home takes considerable and taxing effort, often needing a device, special transportation or another person's help. Short, infrequent absences such as medical appointments or religious services are allowed.
Do I need to have been in the hospital first?
No. A hospital stay is not required for Medicare home health, though many patients start care after one.
What about Medicare Advantage?
Medicare Advantage plans cover home health, but they may require prior authorization and in-network agencies. We check with your plan before care begins.
What if I have private insurance?
Many private plans cover skilled home health. Benefits vary, so our office verifies coverage and explains it before the first visit.
Bring the nurse home.
Planning a hospital discharge or worried about a parent at home? Reach our Canoga Park office and we'll walk you through the next steps, from doctor's orders to the first visit.
Written and medically reviewed by Aida Karamian, RN, BSN, PHN, Owner and Director of Nursing. Last updated