There is a publication put out by the Medicare Rights Center that is an excellent source of useful information on all aspects of Medicare. Recently, it covered a topic that is of great importance to many people. If this topic does not necessarily pertain to you at the moment, I urge you to read the article anyway. Chances are really good that it will affect the lives of your parents, your spouse or you at some point.

This article is republished with permission from the Medicare Rights Center. For more information, visit http://www.medicarerights.org and http://www.medicareinteractive.org.

Dear Marci,

I have multiple sclerosis and my doctor recommended I receive Medicare-covered physical therapy in my home as part of the home health care benefit. I will always need physical therapy to maintain my multiple sclerosis but I heard Medicare will only cover home health services if you are expected to make a full recovery. Will Medicare pay for my home health care even if my condition is chronic?

- Howard (Decatur, GA)

Dear Howard,

Medicare should cover your home health care services from a Medicare-certified home health agency (HHA) even if you have a chronic health condition. Although you may hear otherwise, Medicare covers skilled nursing and therapy services intended to help you maintain your current ability to function or to prevent or slow your functioning from getting worse.

Remember, there are four requirements that must be met for you to be eligible for the Medicare home health care benefit. You must be homebound, you must need skilled nursing care or skilled therapy services, your doctor (or other primary care provider) must have a face-to-face meeting with you to develop a plan of care, and you must receive your home health care services from a Medicare-certified home health agency.

Medicare should not deny you coverage of home health care services if you meet these four requirements even if your health condition is chronic. You also cannot be denied care because the care will only maintain and not improve your ability to function. Restoration potential, the idea that you can improve or increase your ability to function, is not necessary for Medicare to cover home health care.

You can continue to receive home health care for as long as you qualify for the benefit. Your doctor will need to approve a new plan of care every 60 days for the benefit to continue, verifying the care is medically necessary.

Link:

Medicare and home health care services