Medicare Covers Medically Necessary Home Health Services
Medicare does not usually cover the cost of non-medical home care aides if that is the only type of assistance that a senior needs. However, a senior who is homebound or requires physiotherapy, occupational health support or other medical assistance in the home may receive assistance with the cost of home health care on a part-time basis via Medicare.
Medicare will cover 100% of the costs for part-time home health services. Part-time means less than seven days a week or less than eight hours a day over a period of 21 days. To qualify for home health benefits under original Medicare, a person must have a diagnosis and a relevant prescription from a qualified medical professional. Any home health services must be prescribed by a doctor and reasonably priced, so its important to check the costs of home health services in your area before choosing a provider.
Your Home Health Plan Of Care Must Also Be Regularly Reviewed By Your Doctor
At least once every 60 days, your doctor must make an assessment of your progress toward health goals. Any changes to your health must be reported by the visiting nurse.
These routine measures ensure medical services received at home maintain or slow the decline of an illness or injury over a reasonable period of time, typically 60 days.
But what happens when your home medical needs are more than just short-term or part-time?
Who Is Eligible For Home Health Care
Medicare beneficiaries must meet certain eligibility requirements in order to qualify for home health care.
To qualify for Medicare home health care services, you must:
- Be under the care of a doctor.
- Receive services under a plan of care created by a doctor.
- Have a doctor certify that you need intermittent occupational therapy, physical therapy, skilled nursing care or speech language therapy.
- Receive care from a Medicare-certified home health care agency.
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Will Medicaid Pay For Long
Many Medicare enrollees are qualify for Medicaid due to their limited incomes and assets. Unlike Medicare, Medicaid covers both nursing home care and Home and Community Based Services .
Due to the high cost of long-term care, many states have higher Medicaid income limits for long-term care benefits than for other Medicaid coverage. However, Medicaids asset limits usually require you to spend-down resources before becoming eligible.
What Home Health Services Are Available
Under Medicare Part A , along with Medicare Part B , there are a number of home health services available, including:
- Physical therapy
- Intermittent home health aide services for personal hands-on care
- Osteoporosis drugs .
The services will usually be coordinated by a home health care agency based on what your doctor has ordered for you.
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Medicare Plans Resource For Home Care
Learn about what home health care Medicare will cover and how to pay for home care services that are not covered by Medicare.
Many people need care in their homes to safely accomplish daily activities. Medicare pays for limited home health care provided by skilled professionals, but does not cover long-term or personal care. A recent tracking poll by the Kaiser Family Foundation shows that one in five adults in the United States is either the recipient or the provider of care that is not covered by health insurance. The need for home care continues to rise with the aging population. Affordability and the toll unpaid caregiving takes on friends and families are major concerns.
Does Medicare Cover Durable Medical Equipment
Medicare will cover the cost of medically necessary equipment prescribed by a doctor for in-home use. This includes items such as canes or walkers, wheelchairs, blood sugar monitors, nebulizers, oxygen, and hospital beds. Patients typically pay 20 percent of the Medicare-approved amount for such equipment, as well as any remaining deductible under Part B.
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What Durable Medical Equipment Is Covered By Medicare
The cost of durable medical equipment is covered by Medicare if it is deemed medically necessary, and has been prescribed by a doctor for use at home. The list of covered durable medical equipment includes:
- Blood sugar monitors.
Your client will pay 20% of the Medicare-approved amount for the equipment, and they will be liable for any remaining deductible under Medicare Part B.
Schedule Your Free Home Health Care Services Assessment Right Away
At Personal Health Care, we are proud to be the regions top home health care agency. If you have questions or concerns about qualifying for Phoenixville home care services, we are here to help you get the answers that you need. To arrange your free in-home health care assessment, please do not hesitate to contact our Phoenixville office at 933-6130. We look forward to assisting you and your family.
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When Should You Consider Home Health Care For Yourself Or A Loved One
Home health care is often helpful as you transition from hospital or facility to home after being treated for an illness or injury. You can continue your recovery in your home with assistance from trained healthcare staff and hopefully prevent a return trip to the hospital. Here are some examples of how home health care can benefit you:
- If you need wound care or intravenous antibiotics, a skilled nurse can come to your home to provide skilled care.
- An occupational therapist can help you adapt to your home environment by recommending and teaching you how to use equipment, such as a toilet riser or shower chair.
- A physical therapist can teach you exercises to help minimize your pain.
- A speech-language pathologist can help you devise ways to communicate your needs to your caregivers.
- A home health aide, supervised by a nurse, can assist you with bathing and grooming needs until you can safely care for yourself on your own.
- If you need DME
All home health services provided must be on your plan of care signed by your physician.
Medicare-covered home health care is limited. You may consider home care for help with personal care, household chores, getting to doctors appointments, preparing medications that you self-administer, or companionship. If you or your loved one struggles with dementia or a health condition that requires constant supervision and help, home care may be needed.
Will Medicare Cover Skilled Nursing Care
Medicare will pay for whats considered intermittent nursing services, meaning that care is provided either fewer than seven days a week, or daily for less than eight hours a day, for up to 21 days. Sometimes, Medicare will extend this window if a doctor can provide a precise estimate on when that care will end.
Skilled nursing services are generally required to treat an illness or assist in the recovery of an injury. As the name implies, those who provide this care are licensed to administer medical treatment such as injections, catheter changes, wound dressings, and tube feedings.
The maximum amount of weekly care Medicare will pay for is usually 28 hours, though in some circumstances, it will pay for up to 35. But it wont cover 24-hour-a-day care.
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Who Is Eligible For Medicare Coverage Of Home Health Care
You must have Medicare Part A and/or Part B to be eligible for home health care covered by Medicare. If you have a Medicare Advantage Plan, you will already have both Part A and B and will receive home health care coverage through your plan.
Medicare coverage of home health care depends on specific criteria, including:
- You must be under the care of a physician who routinely reviews and signs off on your plan of care.
- You must be homebound, that is, it is difficult for you to leave your home without help because of your health condition. You may, however, go to doctors appointments and adult daycare programs.
- The home health agency caring for you must be Medicare-certified.
- You must have a documented face-to-face visit with your doctor or a health professional who works with a doctor, such as a nurse practitioner, within 90 days prior to the start of care or 30 days after. Your face-to-face visit must relate to the reason you need home health care.
Medicare-covered home health services are provided by licensed professionals, including skilled nurses, physical and occupational therapists, and speech-language pathologists. You must need either intermittent skilled nursing care or therapy within these parameters:
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Medicare Payment System And Other Policies Create Obstacles To Care
Misunderstanding about the scope and duration of services available under the home health benefit is driven and reinforced by Medicare payment policies. For example, the most recent Medicare payment model, effective in 2020, called the Patient-Driven Groupings Model , changed home health agencies financial incentives and disincentives to admit or continue care for Medicare beneficiaries. For instance, under the PDGM, payments are higher for beneficiaries who are admitted after an inpatient stay and lower for those admitted from home. Further, the PDGMs financial incentives include higher payment rates for the first 30 days of home care and declining payments after the first 60 days.
Similarly, the Home Health Value-Based Purchasing Model, which will be expanded nationwide in 2023, increases or decreases payment to home health agencies based on their performance on measures intended to promote higher-quality care. In practice, however, this payment model rewards health improvement and may incentivize providers to avoid serving people with ongoing, debilitating, and chronic conditions who benefit from services but may not improve or improve quickly.
What Happens If The Person Applying Transfers Resources For Less Than Fair Market Value
Medicaid must look at any transfer of resources made by the applicant or applicants spouse which occurred during the 60 months before the application date or at any time after application. Transfers for less than fair market value are presumed to have been done to qualify for Medicaid, unless the applicant provides convincing evidence that the transfer was done exclusively for another purpose. If it is determine that resources were transferred to qualify for Medicaid, the person who needs long-term care will not be eligible for payment of facility care or waiver services for a specified period. Medicaid uses the difference between the value of the transferred item and what the person received in return to determine how long the person will not be eligible for payment.
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Medicare Coverage Of Home Health Care
Home health care aims to provide treatment for an illness or injury within the comfort and privacy of your home.
If you qualify, Medicare covers a range of services if theyre reasonable and necessary for your treatment.
About 12,000 home care agencies provided care to 3.4 million Medicare beneficiaries in 2017, according to Kaiser Health News.
Home Health Services Covered by Medicare
- Home Health Aides
- These professionals can assist with tasks of daily living, such as bathing, dressing or going to the bathroom. These services are only covered if you also currently receive skilled nursing or therapy.
- Skilled Nursing Care
- A registered nurse or a licensed practical nurse can provide skilled nursing care. Services may include giving IV drugs, administering certain injections, tube feedings and changing bandages.
- Occupational, Physical and Speech Therapy
- Professional therapists can provide services to help you improve your ability to perform everyday tasks such as speaking or walking.
- Medical Social Services
- Services can include counseling or help finding resources in your community for emotional support. Medicare does not cover these services unless you already receive skilled care.
- Medical Supplies
- This can include items such as catheters and wound dressings provided by your home health agency. Medicare may also cover some of the cost for durable medical equipment, such as a wheelchair or walker.
What Home Care Services Does Medicare Cover
The primary objective of Medicares home care program is to provide seniors with short-term skilled services in the comfort of their own homes as an alternative to recovering in a hospital or skilled nursing facility.
Skilled nursing services are those that must be provided by a qualified health professional, such as a Registered Nurse or a Licensed Practical Nurse .
Examples of these services include:
- Monitoring of a patients vital signs and overall health
- Wound care for a pressure ulcer or surgical incision
- Administration of intravenous drugs or nutrition therapy
- Catheter changes
- Patient and caregiver education
Skilled therapy services are those that must be provided by or under the supervision of a licensed physical therapist, occupational therapist or speech-language therapist.
- Physical therapy exercises typically focus on improving and restoring strength, balance and range of motion for optimal physical function.
- Occupational therapy assists in regaining the ability to independently engage in activities of daily living and adapting these tasks or the surrounding environment to improve functionality and accessibility.
- Speech-language therapy helps patients regain the ability to speak and communicate as well as overcome swallowing difficulties .
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Examples Of What The Home Health Staff Should Do:
- Check what youre eating and drinking.
- Check your blood pressure, temperature, heart rate, and breathing.
- Check that youre taking your prescription and other drugs and any treatments correctly.
- Ask if youre having pain.
- Check your safety in the home.
- Teach you about your care so you can take care of yourself.
- Coordinate your care. This means they must communicate regularly with you, your doctor, and anyone else who gives you care.
What Parts Of In
In-home care can cover a wide range of services, but theyre not all covered by Medicare. According to the Medicare site, the in-home care services covered by parts A and B include:
Medicare covers the other 80 percent of the costs under your Part B plan.
- Part-time or occasional skilled nursing care
- Part-time or occasional health aide care
- Physical therapy
- Occupational therapy
- Speech-language therapy
- Medical social services, such as workers who help make sure youre being billed for the right things and not being abused or taken advantage of by other people on your case
- Durable medical equipment needed to treat your condition
All of these services are covered under parts A and B of Medicare. The prescriptions you receive as part of your treatment are covered by Medicare, too, whether its under parts A and B or under your Part D prescription plan.
The services themselves will cost you zero dollars out of pocket . The only extra cost youll have for home health services is 20 percent of whatever durable medical equipment is needed for your services. Medicare covers the other 80 percent of the costs under your Part B plan.
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Supportive Services For Virginians Who Do Not Qualify For Medicaid
If you do not qualify for Medicaid and do not meet the nursing home level of care, you may still qualify for some personal assistance services if you are physically disabled and need help with activities of daily living like eating, dressing, or bathing. Virginias Department for Aging and Rehabilitative Services offers personal assistance services through the Personal Assistance Services Program. Note that you cannot participate in the PAS program if you qualify for any of Virginias Medicaid waiver programs. To apply, contact Virginias PAS program.
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When Does Medicare Not Cover In
In most cases, Medicare doesnt cover these types of in-home health care.
- Home health aides, when the only care you need is custodial. That means you need help bathing, dressing, and/or using the bathroom.
- Round-the-clock care
- Homemaker services, like cleaning, laundry, and shopping. If these services arent in your care plan, and theyre the only care you need, theyre generally not covered.
Its important to know that just because your doctor might recommend home health care, Medicare doesnt automatically cover it. It depends on your situation.
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What Home Health Care Isnt Covered By Medicare
Medicare doesnât cover personal errands that arenât directly related to your care. These services include:
- Grocery shopping
- Cleaning the house
Medicare also doesnât cover many long-lasting supplies. Home health care agencies usually donât use these types of items for your treatment. These supplies include:
- Motorized stairway elevators
Medicare doesnât cover prescription drugs as part of home care.
Finding A Medicare Certified Home Health Agency
Medicare will only pay for your home health care if you choose a home health agency that is Medicare certified to ensure they meet federal health requirements.
Before you choose a health agency, make sure that:
- The health agency is Medicare-certified
- It offers the specific health care services that you require
- It is recommended by your doctor or hospital
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Home Health Patient Rights
As a person with Medicare, you have certain guaranteed rights and protections. By federal law, patients of a Medicare-approved home health agency also have these rights:
- Choose your home health agency.
- Have your property treated with respect.
- Be given a copy of your plan of care, and participate in decisions about your care.
- Have your family or guardian act for you if you are unable.
The home health agency must give you a written copy of your rights. For more information on your privacy rights as a home health patient, read the Home Health Agency OASIS Statement of Patients Privacy Rights.
