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What does it take to qualify to get insurance to cover home care from an agency?
I know all insurances are different, but how about Medicare?
Ok Greg ... The easy answers are these (below .. directly from Medicare's mouth) but they'ye not even close to what you get! Agencies refuse to "put out" aides anymore. My Dr has called all over Tucson & can't find one yet to take me on.
Medicare provides coverage for home health care under both Parts A and B.
In addition to having either Medicare Part A or B, you must meet a few additional requirements to be eligible for Medicare to cover home health care. You must:
* be homebound;
* need skilled care on an intermittent or part-time basis;
* get services from a Medicare-certified home health agency (HHA); and
* have a doctor's plan of care.
Medicare defines homebound to mean that a person is generally unable to leave home and leaving home requires a “considerable and taxing effort.” Whether or not your mother qualifies as homebound is decided by a doctor’s evaluation over an extended period of time. Leaving home for short periods to get medical care or for special non-medical events, such as a family reunion, funeral or graduation would not disqualify your mother. Attending religious services or taking an occasional trip to the beauty parlor is also allowed.
Skilled care includes either skilled nursing care or skilled therapy services. Skilled nursing includes care from Registered Nurses (RNs) and Licensed Practical Nurses (LPNs). Skilled therapy includes care from licensed physical, occupational and speech therapists. Services covered include, but are not limited to, monitoring and evaluation, teaching and training, administration of medications, tube feedings, catheter changes, wound care, therapeutic exercises, gait training, and maintenance therapy.
If you are found eligible, the agency will draw up a plan of care. This plan details the care you will receive and the frequency of services over the next 60 days. If your mother still meets the necessary requirements after 60 days, the home health agency can draw up a new plan of care.
As long as she continues to qualify, there is no time limit on the benefit under Part B. Under Part A, she would be limited to 100 visits. No matter which part you are covered under, Medicare pays the full cost of services.
OR ........
As long as your doctor certifies that you're homebound and needs a skilled nurse Medicare will cover services from a Medicare-certified home health agency.
Medicare home health coverage includes skilled services, such as the nursing care, along with a limited number of hours per week of personal care provided by home health aides, such as help with bathing, toileting and dressing.
As a rule, Medicare’s home health care benefit does not cover the following:
* 24-hour-a-day care at home;
* Most prescription drugs;
* Meals delivered to home;
* Home maker or custodial care services, such as cooking, shopping, and laundry;
* Personal care unless, as in your husband’s case, he also needs skilled nursing or therapy care.
(The Medicare hospice benefit may pay for some of these items and services. We will discuss the hospice benefit in a future issue.)
Talk to your doctor about your home health care needs. Many doctors do not know about the Medicare home health benefit. Give your doctor the name and number of a Medicare-certified home health agency (HHA) and ask him to call them and discuss the nature, frequency (how often) and duration (how long) of your husband’s home care needs.
You can get a list of Medicare-certified home health agencies in your area from the Yellow Pages or the Eldercare Locator. You can call the HHAs directly and ask them to assess your condition to determine if you qualify for Medicare-covered home health care. Be sure to keep a list of a few other HHAs in case the first one you or your doctor calls doesn’t work out. | 
