HomeHealthcareHow Do I Qualify For Home Health Care Under Medicare?

How Do I Qualify For Home Health Care Under Medicare?

When it comes to healthcare, the USA made sure every aspect of it was covered. One of the best-running healthcare systems is Medicare which is available for senior citizens above 65 years of age.

While care is a broad term and not everyone can be trusted with it, Medicare makes sure that the nursing staff and therapy professionals are certified and have a good reputation.

When it comes to medicare, certain requirements need to be fulfilled before you can get the help you need. It is not as complicated as it sounds, but to make sure the patient is receiving proper in-house care, the paperwork needs to be verified.

Medicare For the Citizens

Medicare is a Federal government program that provides healthcare coverage for senior citizens above the age of 65 years. The age bracket can be lowered for those who cannot function on their own and needs to be taken care of 24/7.

For citizens above 65 years of age, medicare provides health insurance. In cases of appeal for patients below the age of 65 years, a requirement of social security disability insurance is provided.

Medicare is not entirely free; even though an estimated amount of $170 is provided to the eligible citizen but most of the costs are still paid for by the pocket, such as the premiums, deductibles, co-company costs, etc. While a bigger chunk of health is covered by Medicare, dental care, routine eye checkups, and other cosmetic procedures are not included.

When Do I Qualify For Medicare?

Medicare is formulated for senior citizens of the US; there is no doubt that the federal government provides almost free health care to their citizens but to maintain an organizational display and proper channeling of the system, a timeline has been specified.

At the age of 65 years, any US citizen is eligible for Medicare, but for using this facility, it is better to register three months before turning 65 years.

There is no hard and fast rule, but it is better to get the signup on time. The gap in your coverage can delay your medicare. In most cases, a small penalty is also charged for late registration.

Before turning 65 years, it is best to sign up for both Part A and Part B of Medicare, which is Hospital Insurance and Medical Insurance. These help in easily providing health care when required.

Medicare Requirements To Qualify

Health care is expensive, and for that sole reason, Medicare has different plans for disabled and home-bound patients who need continuous medical care. But to verify your state, medicare asks for specific paperwork that has been divided into medicare part A and medicare part B. These verifications are important for the amount of monthly medicare, the requirement of a skilled nurse, and the hours of care.

Every citizen in need of medicare should fulfill the following requirements to be eligible for Medicare.

1.     The citizen must be under the care of a doctor; the care should be precisely planned out. The treatment plan should be adhered to, and it should have an ending period. Regular visits and examinations are required. This will be verified by the hospital and the doctor.

2.     Apart from a doctor’s care, your consulting doctor should certify that you need more than frequent visits. This should include;

a.     A need for an intermittent skilled nurse who is not only around to draw blood but provides care and assistance in daily tasks. These tasks can include bathing, changing clothes, cleaning, grooming, catheter change, etc.

b.     If the doctor verifies a need for a speech therapist, physical therapy, and or occupational therapy. These requirements should be consistent with your condition.

c.     The condition treated by the doctor and the requirement for in-house care should have improved predictability.

d.     The conditions that are deteriorating by nature should be maintained by physical therapy. A skilled therapist should keep in check the maintenance of the condition.

e.     You must be homebound, and your doctor is supposed to verify that.

After achieving all these verifications, a citizen above 65 years of age is eligible for Medicare. home health care insurance is for senior citizens; for younger citizens, medicare can also be applied through social security disability insurance.

How Does Medicare Work for Qualified Citizens

Medicare does cover the maximum cost of health care, but it has been divided into two major parts. Part A and Part B, these two facilities differentiate upon the situations and do overlap after a certain time. Once you have qualified for medicare by the federal government and by your doctors, Part A of your Medicare commences.

Part A of your medicare covers your expenses after your consecutive 3-day stay in the hospital or skilled nurse facility. This facility starts within 14 days of your medicare commencement. For the next 100 days, part A of Medicare will cover all the expenses, and then it will convert into part B. 

If you commence with your Part B of Medicare, that will include your home health care and skilled care if you are homebound. For this specific part of Medicare, you do not need a prior stay at a hospital or a skilled nursing staff.

There are no deductibles or coinsurance on part B of Medicare. An estimated amount of $170 will be provided depending on your condition and requirement for medical care.

Qualifying Before 65 years of Age

The disease can strike anyone regardless of age. However, age is a major factor in disease and limitations.

The federal government understands the widespread of disorders and how it takes a financial toll on the family.

For the same reason, Medicare also covers those disabled individuals who have a social security disability number or have been diagnosed with end-stage renal disease. 

For disabled individuals below the age of 65 years, there is a two-year waiting period which includes monthly checks from the SSDI. After the 24-month waiting period, Medicare enrolls them in the system by the start of their 25th month of SSDI check. 

The waiting period depends on the type of disability as well. Such as, if you have Amyotrophic Lateral Sclerosis or ALS, Medicare will begin at the start month of your SSDI benefits.


Medicare is a lifesaving organization that helps provide healthcare to the less unfortunate and senior citizens.

This includes medical and hospital insurance, which includes a wide variety of treatments that are required by the patients.

The age of 65 years is mandatory for this facility, but this aid can be used before this age, depending on the disability of the individual.

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