Does Medicare Cover Home Health Care in Florida?
Medicare may cover skilled home health care at home when a doctor orders it and you meet the coverage criteria. It does not cover ongoing help with bathing, meals or companionship. Health at Home is a Medicare-certified agency serving Palm Beach, Broward, Martin, St. Lucie and Indian River counties, and we provide both kinds of care.
- Medicare Certified
- ACHC Accredited
- 25+ Years Serving Florida
What Medicare home health actually covers
When a doctor orders home health and Medicare’s criteria are met, coverage can include:
- Skilled nursing, including wound care, injections, catheter care and medication management
- Physical therapy to rebuild strength, balance and mobility
- Occupational therapy for dressing, bathing and the tasks of daily life
- Speech therapy for speaking, understanding and swallowing
- Medical social work, including help with resources and planning
- Home health aide visits, but only while skilled care is also being provided
Medicare home health is intermittent. It is a course of treatment with a beginning and an end, not ongoing daily support.
What Medicare home health does not cover
This is where most families are surprised, so it is worth stating plainly. Medicare home health does not pay for:
- Ongoing help with bathing, dressing and meals once skilled care has ended
- Companionship, housekeeping, laundry or errands on their own
- Around-the-clock or continuous care at home
- A caregiver who stays in the home
Those services are real and families need them. They are simply paid for a different way, which is what home care is. If that is what your family is looking for, our home care page covers what it includes and what it costs.
What about other insurance? Medicaid covers both home health and home care for income-qualified seniors, though coverage amounts vary by state. If you have a long-term care insurance policy, it may cover home care services that Medicare will not. We accept most insurance plans, including Medicare, Medicaid and long-term care insurance, and we will check your coverage for you before care begins.
Who qualifies
Medicare generally requires all of the following. A doctor decides whether they are met.
- A physician has seen the patient and ordered home health care
- The patient needs skilled nursing on an intermittent basis, or physical therapy, speech therapy or continued occupational therapy
- The patient is homebound, meaning leaving home takes considerable effort and is not advised
- The care is provided by a Medicare-certified agency
Health at Home is Medicare-certified. If you are not sure whether your family member qualifies, call us and we will talk it through, and we coordinate directly with the physician’s office to put the order in place.
What happens when Medicare coverage ends
Every Medicare home health episode ends. The therapy goals are met, or the skilled need resolves, and coverage stops. For a lot of families that is the hardest moment, because the person at home still needs help with the ordinary parts of the day.
Most agencies do only one line of business, so the family gets a discharge date and starts looking for someone new. Health at Home provides home care as well. When the Medicare episode closes, the same agency continues, with the same office, the same records and often the same familiar faces. Nothing starts over.
How to start Medicare home health
01
Talk to the physician, or call us and we will contact the physician’s office for you
02
The doctor writes the order and we coordinate the paperwork
03
A registered nurse completes the assessment at home and builds the plan of care
04
Care begins within 24 hours
If your family member is being discharged from a hospital or rehabilitation facility, the discharge planner can refer directly to us. You can also ask for us by name.
Questions families ask
Does Medicare cover home health care in Florida?
Medicare may cover skilled home health care when a doctor orders it, the patient is homebound, there is a skilled need, and the agency is Medicare-certified. A physician decides whether those criteria are met.
Does Medicare pay for a caregiver to help with bathing and meals?
Not on its own. Medicare may cover home health aide visits while skilled nursing or therapy is also being provided, but it does not pay for ongoing personal care once skilled care ends. That is home care, paid privately.
What does homebound mean?
It means leaving home takes a considerable and taxing effort, and a doctor has advised against it or the person needs help to do it. It does not mean never leaving the house. Medical appointments and short outings are allowed.
How long does Medicare home health last?
It is intermittent and episodic rather than ongoing. The physician sets the plan of care and reviews it, and coverage continues only while the skilled need and the criteria are met.
What is the difference between home health and home care?
Home health is skilled medical care, ordered by a doctor, that Medicare may cover. Home care, which the industry also calls private duty, is hourly non-medical help that families pay for directly. Health at Home provides both.
What happens when Medicare stops paying?
Our home care team continues with the same agency, the same office and the same records. There is no new intake process and no gap in care.
Not sure whether your family member qualifies?
Call our Port St. Lucie office or our Boynton Beach office and we will talk it through. We coordinate with the physician’s office directly.