With age comes wisdom and wonderful experiences with family and spending precious time with grandchildren. Growing older also brings its share of health challenges; some of which are managed with routine medical visits and maintenance. Other health issues are of more serious nature and require in-home care.
Home health care includes a wide range of services to treat injury or lingering illness, including professional nursing care, homemaker services, assistance with personal needs, therapy, medical supplies, and medical social services. Medicare’s home health care program is an invaluable tool to help cover the cost of these benefits; however, you must meet certain conditions in order to receive this coverage.
Medicare Coverage for Home Care Services
Medicare covers home health care provided you meet these criteria:
- You are homebound, which means you have great difficulty physically leaving your home without assistance.
- You require intermittent, skilled nursing or therapy care. In this case, intermittent is defined as needing care at least once every 60 days or no more than once a day for a maximum of three weeks. Medicare will extend coverage for a longer period if you need additional care, provided your needs are “predictable and finite.”
Skilled care is that administered or supervised by a professional. Skilled therapy services include physical, speech, and occupational therapy.
- You must have an in-person meeting with a doctor within 90 days of starting home care, or within 30 days after the first day of care. Care sessions can be in an office, hospital, or even video conferencing.
- You must present a signed certification from your doctor verifying you are homebound and require home care. The certification will also include a certification confirming your doctor’s care plan addressing your homebound status. Your doctor should review the home health plan every 60 days.
Keep in mind that if you only need occupational therapy, you cannot receive home health care through Medicare if you are qualified through another plan. At the close of that plan, Medicare-based occupational therapy is then covered.
Home Health Benefits Provided by Medicare
If you qualify, the following home health care benefits may be offered under Medicare’s Part A:
- Physical, speech, and occupational therapists to assist in regaining the ability to walk, perform routine tasks, address speech problems, and related conditions.
- Home health services to assist with personal tasks including dressing, preparing meals if needed, and going to the bathroom.
- A skilled nurse in the home on a part-time basis, totaling no more than eight hours a day for no more than 21 days. Services in this area can include wound dressings, changing catheters, injections, and feeding through a tube.
- Social services medical counseling directly related to a condition.
Common Medicare Coverage Scenarios
Medicare coverage typically falls into three main categories:
Short-term care for conditions likely to improve
If a patient if expected to recover from specific forms of treatment, Medicare may cover these costs provided the patient had a recent hospital stay of at least three days, entered Medicare-approved care within the next 30 days, and require doctor-certified care.
Recovery from an injury
If a doctor verifies medical necessity to fully recover from an injury, Medicare may cover this type of care. In addition to the above-mentioned therapies and services, this can also include wheelchairs, mobility aids, and home oxygen services. A doctor must verify the patient is homebound and qualified to receive these services and must reorder the service every two months for as long as the care is needed.
In the unfortunate event a patient has terminal illness from which he or she is not expected to recover within six months; Medicare will cover in-home hospice care, nursing home care, or care at a hospice facility. Medicare may also cover other related services such as medical equipment and supplies, prescription drugs to control pain and symptoms, grief counseling for patient and family, and short-term respite care.
Remember, however, that if Medicare initiates funding for hospice or respite care, funding will stop for other areas, including prescribed drugs. It is also important to note that Medicare covers seniors over the age of 65 and is also available for some people under age 65 with specific disabilities. Examples of these diseases include permanent kidney failure, renal disease, and Lou Gehrig’s disease. Be aware of coverage details regarding long-term illnesses to ensure you are covered in a way best suited to your scenario.
How can I receive Medicare health care coverage?
In order to receive Medicare health benefits, a patient must obtain care from a qualified doctor. Any home health care must be administered by an agency certified through Medicare, and services received require pre-approval.
If Medicare does not cover your home health care needs, you can review your home state’s Medicaid program, as well as Medicare’s Advantage plan. Contact a local agent or your doctor for more information related to your particular situation.
If you or your family member is considering in-home care as part of a plan to age in place, contact Family Matters In-Home Care today for a free consultation. Our team is dedicated to supporting your family and helping older adults enjoy life in the comfort of their own home for as long as possible.
Some of the services offered by Family Matter In-Home Care include: Alzheimer’s & Dementia Care, Bed & Wheelchair Transfer Assistance, Companionship, Housekeeping & Meal Preparation, Personal Care, Recovery Care, and Transportation.