Monday, April 15, 2024

What Kind Of Home Care Does Medicare Pay For

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Medicare Home Health Care Coverage

Medicare & You: Home Health Care

Original Medicare covers various home health care services through Medicare Part A and Part B. Eligible services include

  • Skilled nursing .

  • Home health aides .

  • Physical therapy.

  • Injectable osteoporosis medicines for women.

  • Durable medical equipment and medical supplies for home use.

These services are also covered by Medicare Advantage plans, which are offered by private insurers that contract with the federal government, though additional network restrictions may apply.

The following home health services generally aren’t covered:

  • 24-hour home care.

  • Personal/custodial care such as dressing, bathing or toilet assistance .

  • Domestic services like cleaning, laundry or shopping.

Please Answer A Few Questions To Help Us Determine Your Eligibility

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Progressive health care professionals often encourage people to get out of hospitals and nursing facilities and into their own or family members’ homes while recovering from injury or illness. With less honorable motives, insurance companies also pressure hospitals to release patients earlier so that if they continue to receive care, it will be a less costly variety at home.

In response to both these movements, many new home health care agencies have sprung up. You’re increasingly likely to find such an agency in your local area. Most are able to provide care for patients who no longer need high-level care in a hospital but who still require part-time nursing or rehabilitative therapy.

Whos Eligible For Home Health Services

If you have Original Medicare , you may be eligible if:2

  • Youre under the care of a doctor and get services under a plan of care created and reviewed by a doctor.
  • You must need, and a doctor must certify that you need, 1 or more of these services:
  • Intermittent skilled nursing care
  • Physical therapy
  • Speech-language pathology
  • Continued occupational therapy
  • A doctor can certify that youre homebound. This means your illness or injury causes you to have trouble leaving your home without using a cane, walker, crutches or wheelchair. Or, you require help from another person and/or need special transportation.
  • The home health agency caring for you is approved by Medicare.
  • Note: If you need full-time skilled nursing care for a long time, its unlikely that youll be eligible for home health care services.3

    Recommended Reading: What Age Does Medicare Eligibility Start

    Is Medicare A Health Insurance Plan That Covers Medical Social Services

    Medicare will cover medically necessary services that assist patients in coping with the emotional consequences of an injury or disease. These may include counseling sessions conducted in the home by a professional therapist or social worker. Medicare covers these services only if the patient is receiving competent nursing care.

    Pros And Cons Of Home Health Care

    Does Medicare pay for hospital beds for home use?

    The benefits of properly administered home health care can be enormous. The fact that Medicare will pay for an unlimited number of home health care visits with no copayments makes home care a very good financial value compared to recovery in a hospital or nursing facilityin addition to the recuperative benefits of being at home.

    Being in your own home or even that of a friend or relative is often more conducive to a speedy recovery than the impersonal and sometimes frightening environment of a hospital. You have familiar things around you, your friends and family can come and go without worrying about “visiting hours,” and they can lend a hand with your care. You have greater privacy and are free from dreadful hospital routines and late-night noise and lights.

    On the other hand, home health care is not always the best solution. Hospitals sometimes push people out the door before they are well or strong enough, and as a result the people may take longer to recover at home, or suffer more pain and discomfort at home, than they would have if they had remained in the hospital just a few days more. This is particularly true when a patient does not have family or friends available to supplement the care provided by a home care agency.

    Recommended Reading: How Much Is Medicare Deductible For 2021

    Who May Be Eligible For Home Health Aides Under Medicare

    To be eligible for home health care coverage under Medicare, you have to meet certain conditions. For example, you must:

    • Be under the care of a doctor whoâs regularly reviewing your care plan
    • Be homebound , meaning that you have trouble leaving your house without a walker or wheelchair
    • Be certified by a doctor that you need one or more of these care services:
    • Intermittent skilled nursing care
    • Physical therapy, speech-language pathology, or continued occupational services

    You donât have to stay in your home 24/7 to qualify as homebound, however. You can still leave the house occasionally to receive medical treatment or for short, non-medical events, such as religious services.

    What Should Caregivers Know About Medicare

    Medicare is a federal government health insurance program primarily for people age 65 and older. It may also cover younger adults with disabilities.

    There are different plans and coverage options within Medicare.

    Your loved one or family member may be enrolled in Original Medicare, which includes two components: Part A for hospital insurance and Part B for medical coverage.

    In this case, your loved one may also have a stand-alone Part D prescription drug plan. Some Original Medicare beneficiaries also have a supplemental insurance plan, also known as Medigap, which helps cover deductibles and other costs.

    Part D and Medigap plans are administered by private companies that Medicare reimburses.

    Alternatively, your friend or family member may be enrolled in a Medicare Advantage, or Part C, plan.

    This option is also administered by a private company. Medicare Advantage plans must provide the same basic coverage as Original Medicare but may also bundle other benefits such as drug coverage, vision, hearing and dental into a single plan.

    All Medicare enrollees are issued a red, white and blue Medicare card. They may also have a separate Medicare Advantage or Part D card, if theyre enrolled in these programs.

    If you cant locate these cards, you and your loved one can call the Medicare helpline together. Or, your loved one can complete a form authorizing Medicare to release information to you.

    To learn more, call Medicare at 1-800-MEDICARE .

    Also Check: What Are The Five Steps In The Medicare Appeals Process

    How To Sign Up For Medicare

    Many people are automatically enrolled in Medicare parts A and B when they turn 65 and start getting Social Security benefits. If you want extra coverage, you also have the option of signing up for a Medicare Supplement or Medicare Advantage plan. You can sign up for those plans directly with the insurance provider . Note that while Medicare Supplements and Medicare Advantage offer more coverage, youll have to pay an additional monthly premium.

    If you werent automatically enrolled in Medicare upon turning 65, you can sign up during your Initial Enrollment Period, which begins three months before your 65th birthday and ends three months after. Each year, there is also a General Enrollment Period from January 1st to March 31st, when all eligible adults can enroll in Medicare.

    If youre eligible for Medicare but not currently enrolled, you can easily sign up online via the Social Security Administration website during an enrollment period. You can learn more about the process on the official Medicare website.

    Is There Any Cost For Homecare When Using Medicare Benefits

    4 Seniors: Does Medicare cover home health care?

    Before any care begins, the agency should tell you how much youre going to be responsible for paying when the medical services are over.

    The agency will also talk to you about any services theyre being asked to provide that are not covered under Medicare, and how much those services cost to provide.

    Your responsibilities need to be discussed with you and it needs to be provided to you in writing so that you are very well aware of what your costs will be.

    The homecare agency has a responsibility to you to ensure that you receive all of the care as the doctor has ordered/prescribed for you. The agency will also be responsible for ensuring that your discharge plan is put in place so you are safe to be on your own.

    You might like to read: Transitioning To Assisted Living A Guide For Seniors And Caregivers

    Don’t Miss: How To Verify Medicare Eligibility Online

    Does Medicare Cover Home Health Aides In Florida

    If youre struggling to understand Medicare in Florida, Connie can help. Ask Connie your question, and a local, licensed agent will help you navigate your Medicare journey. Complete this form to have your question answered. It could be featured on Dear Connie.

    Dear Connie,

    My husband has multiple chronic conditions. While we have specialists coming to the house to support him, I hope to get help with his daily personal care needs. Its become overwhelming for me to manage. Im wondering, does Medicare cover home health aides in Florida?

    Seeking help,Shirley from Spring Hill, Florida

    Find the right Medicare plan for you

    Im so happy youre reaching out and seeking the support you need.

    Yes, Medicare covers home health aides under certain conditions.

    For example, if you were only seeking a home health aide and there werent other services being provided in the home, your husband would not be eligible. Home health aides are not offered as a stand-alone service through Medicare.

    Agent tip:

    Home health aides are not offered as a stand-alone service through Medicare. To qualify, the Medicare beneficiary must also be receiving in-home skilled care.

    However, since it sounds like your husband is receiving either skilled nursing care, physical therapy, occupational therapy, speech-language pathology, or other home health services, hed likely qualify.

    Who Can Receive Home Care Covered By Medicare

    Individuals must have coverage through Medicare Part A and/or Medicare Part B and meet the following four criteria as set forth by Medicare.gov:

  • Eligible recipients must be under the care of a doctor. The doctor must prescribe a plan of care that involves medically necessary services for the treatment or maintenance of a health condition. This care is intended to be short term, so the doctor is required to re-certify the plan of care every 60 days.
  • Eligible recipients must be certified by a doctor as homebound. This means it requires a considerable and taxing effort to leave the home because of reliance on a mobility aid , special transportation, or the assistance of another person to do so. An individual does not have to be bedridden to be considered homebound and can still qualify even if they are able to leave home for medical treatments, adult day care, and short, infrequent nonmedical outings, such as religious services and family gatherings.
  • Eligible recipients must have a doctors certification of need for at least one of the following services:
  • Home health care services must be provided by a Medicare-certified home health care agency.
  • Recommended Reading: Does Medicare Cover Chemotherapy Drugs

    What If My Home Health Care Is Ending Too Soon

    If your home health care is ending, it is likely because you are getting better and no longer need it. But that is not always the case and you may feel that your home health care coverage is ending prematurely. If so, you can file a fast appeal to continue home health care.

    When you receive your NOMNC, it will let you know when your services are ending and instructions on how to file for a fast appeal. A Beneficiary and Family-Centered Care Quality Improvement Organization will go over your appeal, discuss your condition with your doctor, and notify you of their decision within three days after the end date on the NOMNC.Medicare.gov, Medicare & Home Health Care, Accessed December 15, 2021

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    What Home Healthcare Is Covered By Medicare

    How Long Does Medicare Pay for Rehab?

    The goal of Medicare home health care services is to improve your quality of life and increase your independence at home.

    Home health services may include:

    • occupational therapy
    • physical therapy

    Occupational therapy helps you adapt to your physical limitations by showing you how to bathe, dress, prepare meals and transfer out of bed independently. An occupational therapist evaluates your home for safety and can suggest modifications like stair rails, grab bars and devices that make your home environment safer and easier to navigate. Physical therapy helps you build back your leg strength, endurance and ability to walk. If you have stairs in your home, a physical therapist can train you to safely climb your stairs again.A stroke can cause such disabilities as language impairments and problems swallowing. A speech therapist can perform an evaluation and develop a treatment plan to improve these functions. Scheduled visits may include mealtimes to offer tips on swallowing food.

    Also Check: Which Is Best Medicare Supplement Or Advantage Plan

    How Do I Find Medicare

    Medicare.gov has a search and comparison tool to help you find certified home health agencies in your area that Medicare covers.

    If you have coverage from a private Medicare Advantage plan, rather than original Medicare, you may have to use an agency that works with that Advantage plan. Talk with a Medicare Advantage plan representative about coverage details and requirements.

    Before you start receiving care, the agency should let you know, both verbally and in writing, of services provided that Medicare wont cover and what you can expect to pay for them.

    Keep in mind

    You may be able to get additional caregiving support through local and state programs, which may provide services such as adult day care programs, equipment, meal delivery, respite care for caregivers and transportation. You can find out more about programs in your area through your Area Agency on Aging. Type your zip code or city and state into the U.S. Administration on Agings Eldercare Locator or call 800-677-1116, to find contact information for your local agency and other resources.

    Ask Questions About Home Nursing Care In Phoenixville Today

    At Personal Health Care, we are committed to providing exceptional home health care services to children and adults. If you have questions about Medicaid and nursing home care coverage, we can help you get answers or put you in touch with someone who can. To schedule a free in-home health care assessment, please do not hesitate to call us today at 933-6130. Based in Phoenixville, we serve communities all over Southeastern Pennsylvania.

    Recommended Reading: Ohio Medicaid Customer Service Phone Number

    Also Check: Which Is Better Traditional Medicare Or Medicare Advantage

    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 .

    What Are Home Health Care Services

    Medicare & You: Nursing Home / Long-Term Care

    Home health care services are provided in your home by skilled medical professionals who are operating in accordance with physicians orders. Home health care services are limited in scope and short-term in duration. The goal of these services is to restore you to your previous level of functioning after an illness or injury or at least help maintain your level of functioning or slow your decline.

    Read Also: How To Pick The Best Medicare Plan

    Which Medicare Parts And Plans Cover Home Health Care

    If youre enrolled in Original Medicare, you will use both Part A and Part B to cover limited home health services, says Parker.

    Some Medicare Advantage plans also offer additional benefits, such as caregiver support services or home modifications. However, the benefits offered for home health care vary widely from plan to plan, so its important to understand the coverage offered before you sign up for a Medicare Advantage plan, adds Parker.

    Medicare Coverage For Home Health Care

    Home health care is for someone who needs to receive skilled nursing care or rehab therapy in their own home. Without home health care, some individuals may not get the health care they need.

    Medicare may cover the following services and items for those who qualify for the benefit.

    • Part-time or intermittent skilled nursing care. Care must be provided by or under the supervision of a professional registered nurse.
    • Physical, speech or occupational therapy.
    • Durable medical equipment and supplies, such as a hospital bed for use at home.

    Medicare beneficiaries who receive any part of the home care benefit may also be eligible to receive additional services, including:

    • Medical social services, such as counseling or resources to help with the health condition
    • A home health aide to help with activities of daily living like bathing and dressing

    Read Also: What Is Traditional Medicare Coverage

    Medicare Advantage May Offer More Comprehensive Coverage

    Private insurance companies run Medicare Advantage. Those companies are regulated by Medicare and must provide the same basic level of coverage as Original Medicare. However, they also offer additional coverage known as supplemental health care benefits.

    These benefits can be used to cover the cost of health care or medical equipment that could reduce the risk of injury, reduce the impact of lost mobility or injury or help a person maintain their health and independence.

    Medicare Advantage covers many services that are excluded from original Medicare. Individual insurers are permitted to exercise discretion when deciding what services to offer under supplemental benefits, so Medicare Advantage customers should contact their insurers to discuss their options before deciding on a care plan.

    We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

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