House calls are when a doctor comes to your home to see you for your medical checkup or appointment instead of you leaving your home and going to the office. Many people wonder if Medicare benefits cover house calls, and the short answer is yes and no.

Medicare did test a house calls program, but it was only in select states for a five-year test. At the end of the five years, they found that house calls did save Medicare money, but doctors would see less than 10 patients a day because the visits tended to take longer. However, home health benefits exist, and it’s like a miniature checkup.

Eligibility for Home Health Services

You have to be under the care of a doctor with a plan of care that they review on a regular basis. Your doctor has to certify that you need at least one of the following to be eligible:

  • Continued occupational therapy
  • Physical therapy
  • Speech services
  • Intermittent skilled nursing care less than eight hours a day

You have to be homebound and have trouble leaving your home or walking without help. The home health agency has to have a certification by Medicare as well. Additionally, a doctor or nurse practitioner has to document that you’ve had a face-to-face visit within the required timeframe. The face-to-face appointment has to be related to why you need home health services.

Home Health Services Medicare Benefits Cover

There are several services Medicare covers under home health visits by a nurse, doctor, or nurse practitioner. They include:

  • Skilled Nursing – This is care that requires a nurse’s skills. The person giving your skilled nursing care must not give services for more than 28 hours a week. Skilled nursing services include tube feeding, injections, giving IV drugs, teaching diabetes care, teaching about prescriptions, or changing dressings.
  • Therapy – Speech, occupational, or physical therapy are covered by Medicare if they’re an effective, safe, and specific treatment for your diagnosis. You can’t safely perform the therapy on your own, and the therapy is necessary to improve function related to your injury or illness.
  • Home Health Aid – Medicare will pay for intermittent or part-time home health aid help as long as you need this service to treat an illness or injury or maintain your health.
  • Social Services – As long as your doctor thinks you need these services to address your emotional and social concerns, Medicare will pay for social services. This service includes helping you find community-based services or counseling.
  • Medical Supplies – Medicare’s home care program will pay for certain supplies like wound dressings. However, your doctor has to order it. Medicare may also cover the cost of durable medical equipment, up to 80%. If your home care agency can’t give you the durable medical equipment, they’ll usually arrange for it through a third-party supplier. The supplier must participate in Medicare and accept assignment.

Home Health Services Medicare Won’t Cover

There are some benefits your Medicare benefits won’t pay for you to have. If you choose to get them, you’ll pay the full cost on your own. These services include:

  • 24-hour care
  • Homemaker services like cleaning, shopping, or laundry
  • Delivered meals
  • Personal or custodial care like dressing, bathing, and bathroom assistance

If you’d like to find out if Medicare will cover home-based visits and services, talk to your doctor. You can discuss your concerns, and your doctor can arrange for these services if they pertain to your illness or medical condition.

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