Confusion around the definition of “homebound” sometimes prevents eligible patients from receiving beneficial home health service. Medicare and some insurances require patients to be “homebound” in order to receive home care services, but this definition is less strict than the word implies. Below we discuss Medicare’s definition and how you or a loved one may be eligible to receive home care services no matter what type of insurance you may have.
Did you know that you can do all of the below and likely still be considered “homebound” by Medicare’s definition:
- Occasional trips to hairdresser/barber
- Adult day care services
- Family reunions, funerals, graduation
- Special family get-togethers
- Religious services
- Walks around the block
- A drive
Medicare defines “homebound” status as being those patients that require assistance when leaving the home and that when they do, it requires a considerable, taxing effort. As patients recuperate and regain strength with home care services, the “taxing effort” becomes less and less. When the patient no longer requires assistance from either a person or special device to leave home and when the patient no longer is extremely tired after an outing, the patient is usually ready to be discharged from our services. We are a “bridge” for the patients while they heal and learn more about their health care.
Medicaid has removed homebound limitations from its requirements for coverage of home health. As long as a physician determines that home treatment is the most appropriate environment for care, medically necessary home care services can occur in the home.
Private Insurance/Managed Care plans vary in their coverage of home care services and the homebound requirement. Upon receiving a referral, we will work with the insurance company to determine any homebound requirements, copays, and limitations. Mercer Health Home Care will preauthorize services and coordinate with the physician. We will provide the patient with this financial information prior to beginning their care so that they can make an informed decision.
Physicians, hospitals, nursing homes, and others can call Mercer Health Home Care to make a referral for a nurse to make a home visit and determine eligibility for any skilled services. Please call 419-584-0143 with any questions or referrals. The nurses will collaborate with the referring physician after the initial home visit.