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Homebound Status and Medicare Coverage
Medicare patients need to meet several requirements to obtain coverage for home healthcare services. In fact, a doctor must certify that a patient is homebound in order to be eligible for coverage of home health services. Find out what you need to know about homebound status.
What is Homebound Status?
Homebound status is often misunderstood. But it's an important classification for anyone seeking home healthcare services to understand.
According to Lisa Kristosik, Chief Operating Officer at Visiting Nurse Association of Ohio, a doctor must certify that a patient is homebound to be eligible for coverage for home health services, such as:
- Intermittent skilled nursing care
- Physical therapy
- Speech-language pathology services
- Continued occupational services
What's important to note is that, according to Medicare, an individual does not have to be bedridden to be considered homebound.
Rather "homebound" is defined by these conditions:
- Leaving your home isn’t recommended because of your condition.
- Your condition prevents you from leaving home without help (wheelchair, walker, special transportation, etc.), and leaving takes a considerable and taxing effort.
- However, you may leave home for medical treatment, short, infrequent absences for non-medical reasons, like attending religious services.
- You can also get home healthcare if you attend adult day care.
In addition to homebound status, the following are additional requirements for Medicare coverage:
- Your home health agency must be Medicare-certified.
- You must be under the care of a doctor, and be getting services under a plan of care established and reviewed regularly by a doctor.
- You must need, and a doctor must certify that you need intermittent skilled nursing care, physical therapy, speech-language pathology services, and continued occupational services.
- *Note: services may also include medical social services, part-time or intermittent home health aide services, medical supplies for use at home, durable medical equipment, and an injectable osteoporosis drug.*You will have to consult with your home healthcare representative for full details specific to your situation.
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