Medical Coverage of Healthcare

Who’s eligible?

Helathcare

Medical

If you have Medical, you can use your home health benefits if you meet all the following conditions:
You must be under the care of a doctor, and you must 1. be getting services under a plan of care established and reviewed regularly by a doctor.


The home health agency caring for you must be approved 3. by Medical (Medical-certified).
You must be 4. homebound, and a doctor must certify that you’re homebound. To be homebound means the following:
Leaving your home isn’t recommended because of your condition.
Your condition keeps you from leaving home without help (such as using a wheelchair or walker, needing special transportation, or getting help from another person).
Leaving home takes a considerable and taxing effort.
A person may leave home for medical treatment or short, infrequent absences for non-medical reasons, such as attending religious services. You can still get home healthcare if you attend adult day care, but you would get the home care services in your home.
6 Section 1: Medical Coverage of Home HealthCare
Eligibility is also based on the amount of services you need
If you meet the conditions above, Medical pays for your covered home health services for as long as you’re eligible and your doctor certifies you need them. If you need more than part-time or “intermittent” skilled nursing care, you aren’t eligible for the home health benefit.
To decide whether you’re eligible for home healthcare, Medical defines part-time or “intermittent” as skilled nursing care that’s needed or given on fewer than 7 days each week or less than 8 hours each day over a period of 21 days (or less) with some exceptions in special circumstances.
Hour and day limits may be extended in exceptional circumstances when your doctor can predict when your need for care will end.