What conditions must be met for Medicare coverage of home health care?

For Medicare coverage of home health care, one critical condition is that there must be a physician-authorized plan of care, and the patient must be considered homebound. This means that a doctor must formally establish a plan that outlines the needed services, which typically include skilled nursing care or therapy. The homebound status is also essential; it indicates that the patient has a significant restriction in mobility and that leaving the home requires considerable effort or is limited to certain circumstances, such as medical appointments. This requirement ensures that the services provided are necessary and appropriate, aligning with Medicare's focus on coverage for patients who genuinely need assistance in their homes due to medical conditions.

Other options, such as requiring the patient to be a minor or have private insurance, do not align with Medicare's guidelines. Additionally, while care may be frequent, the stipulation for daily or continuous care is not a Medicare requirement, as services are based on medical necessity rather than a specific frequency of care. Thus, the correct condition emphasizes the need for a physician's plan and homebound status to qualify for Medicare coverage.