What types of home health care will Medicare pay for?

Last time out, we took a look at the four conditions under which Medicare will help pay for  your loved one’s home health care services. We established that the recipient must be considered homebound; needs skilled nursing care or skilled therapy services as often as once every 60 days, or as much as once daily for up to three weeks; is receiving care at a Medicare-certified home health agency; or if your doctor signs a home health certification stating that you qualify for Medicare home care because you are homebound and need intermittent skilled care.

In this post, we will be taking a look at those types of home health care services Medicare will help pay for, and those it won’t pay for.

First, let’s take a look at those types of care Medicare will pay for:

  • Skilled nursing services and home health services provided for up to seven days a week for no more than eight hours per day and 28 hours per week (Medicare can cover up to 35 hours in unusual cases).
  • Medicare pays in full for skilled nursing care, including services that can only be performed effectively by a licensed nurse. Injections (and teaching patients to self-inject), tube feedings, catheter changes, observation and assessment of a patient’s condition, management and evaluation of a patient’s care plan, and wound care are some examples.
  • Medicare will also make full payment if you require the services of a skilled home health aide who provides personal care services like help with bathing, using the toilet, and dressing. If personal care is the only thing you require, you don’t qualify for Medicare home care benefit.
  • Skilled therapy services such as physical, speech and occupational therapy services that can only be performed safely by or supervised by a licensed therapist, and that are necessary for treating your illness or injury.
  • Medicare pays in full for medical social services ordered by your doctor to help with social and emotional concerns related to your illness. This might include counseling or help finding resources in your community.
  • Medicare will also make full payment for medical supplies like wound dressings provided by a Medicare-certified home health agency.

Now, let’s take a look at those types of care Medicare will not cover:

  • If you require 24-hour care at home, Medicare is not likely to cover the full cost of your care.
  • Medicare will also not pay for prescription drugs. To get Medicare drug coverage, you need to enroll in a Medicare Part D plan. There are two options available (stand-alone Medicare private drug plan (PDP), and Medicare Advantage Plan with Part D coverage (MADP).
  • All meals delivered to you at home and homemaker or custodial care services (i.e. cooking, shopping, laundry).
  • Unless custodial care is part of the skilled nursing and/or skilled therapy services you receive from a home health aide or other personal care attendant.

Medicare Can Cover the Cost of your Home Health Care. Here’s How.

In a previous post, we looked at certain questions that should be asked when considering home health care service in New Jersey. One of those questions was how much it would cost. A lot of people are not aware of the full range of options available to them to help pay for Home Health Care Services. Beyond what a loved one can afford from savings and income, a variety of options can be explored. Reverse mortgages, life and long term care insurance policies as well as Medicare and Medicaid are some of many options that can be explored to cover the cost of care.

In this post, we will be looking at the requirements of Medicare as a way of payment for home health care services.

Like most federal programs, to qualify for Medicare as a source of paying for your home health services, certain conditions must be met, including being homebound, need for skilled care, and for how long, a doctor’s order and the use of a Medicare certified Home Health agency.

HOMEBOUND

If you or your loved one is considered homebound, you are entitled to having Medicare pay for your home health care. To be considered homebound, you must meet the following criteria:

  • You need the help of another person or special equipment (wheelchair, walker, etc.) to leave your house, or your doctor believes that leaving your house would be harmful to your health.
  • If you find it difficult to leave your home and typically cannot do so.

SKILLED NURSING.

If you or your loved one needs skilled care, including skilled nursing care or skilled therapy services (physical, speech or occupational) as often as once every 60 days, or as much as once daily for up to three weeks.

DOCTOR’S ORDER

Also, you qualify if your doctor signs a home health certification stating that you qualify for Medicare home care because you are homebound and need intermittent skilled care. The certification must also say that a plan of care has been made for you, and that a doctor regularly reviews it. Usually, the certification and plan of care are combined in one form that is signed by your doctor and submitted to Medicare.

  • As part of the certification, doctors must also confirm that they (or certain other providers, such as nurse practitioners) have had a face-to-face meeting with you related to the main reason you need home care within 90 days of starting to receive home health care or within 30 days after you have already started receiving home health care. Your doctor must specifically state that the face-to-face meeting confirmed that you are homebound and qualify for intermittent skilled care.
  • The face-to-face encounter can also be done through tele health. In certain areas, Medicare will cover examinations done for you in specific places (doctors offices, hospitals, health clinics, skilled nursing facilities) using telecommunications (such as video conferencing).

AGENCY

If you or your loved one is receiving your care at a Medicare-certified home health agency (HHA).

Please note, if you only need occupational therapy, you will not qualify for the Medicare home health benefit. However, if you qualify for Medicare coverage of home health care on another basis, you can also get occupational therapy. Even when your other needs for Medicare home health end, you should still be able to get occupational therapy under the Medicare home health benefit if you still need it.

If you have any further questions about todays post, or you want to get to know more about what we do and how Elite Home Care can help, you can get in touch with us through our Contact Us page, we will be more than glad to be of assistance.

In our next post, we will be looking at the types of home health care services that Medicare will pay for, and services it does not cover.

Written by Elite HomeCare’s Admin