Home Healthcare Covered by Medicare?
You’ve undoubtedly put “what does Medicare cover for home health care in Chicago?” into Google and then quickly closed the tab. The sheer number of material and level of detail can rapidly become confusing and overwhelming (and you’ll almost certainly wind up with more questions than when you started). We’ve broken down this crucial subject into a series of commonly asked questions, covering what home health services are available, what services aren’t covered, who is qualified, and how much it will cost.
What is the definition of home health care?
Following an injury or illness, home health care encompasses a wide range of health services delivered in the comfort of your own home. It is an excellent alternative for many people since it is cost-efficient, convenient, and just as effective as care received in a hospital or clinic.
Home health care, also known as home care, supportive care, or in-home care, is offered by a competent professional in the comfort of your own home rather than in a clinic or other group setting.
What are the options for home health care?
There are numerous home health services accessible under Medicare Part A (hospital insurance) and Medicare Part B (medical insurance), including:
- Physical and occupational therapy.
- Occupational therapy services.
- Services in speech-language pathology.
- Skilled nursing care on a part-time basis.
- Social and medical services.
- Part-time (intermittent) home health aide services for personal care.
- Anti-osteoporosis medications.
A home health care agency will usually organize the services based on what your doctor has recommended for you.
What isn’t included?
Home health care is covered by Medicare, but not round-the-clock care (24 hours a day) or meal deliveries. Homemaker services (such as cleaning and washing) and personal care (such as bathing and dressing) are also not covered if it is the only care you require.
What types of people are eligible for in-home care?
You must have Medicare Part A and/or Part B in order to use the available home health care services.
You must also fulfill the following requirements:
- You must be under the supervision of a licensed physician, and your case must be examined on a regular basis.
- You must have a doctor’s note stating that you require skilled nursing care or therapy.
- You must have a temporary need for physical, occupational, or speech therapy.
- You must be housebound, which means you are unable to leave your home without assistance.
- You must receive a doctor’s certification that you are housebound after a documented visit with your doctor no more than 90 days prior to or 30 days after your home health care begins.
- Your doctor has prepared a plan of care for you, which is evaluated on a regular basis and contains what services are required, how frequently they are required, who will perform them, what supplies are required, and what outcomes are expected.
- You should only need expert nursing on a part-time basis (excluding drawing blood).
- The home health agency that provides care must be certified by Medicare.
If you require more than intermittent skilled nursing care, you will not be eligible for home health benefits. You may, however, leave your house for brief outings such as religious services or medical treatment. If you go to adult day care, you will still be eligible.
When it comes to home health care, how much does Medicare cover?
You don’t have to pay anything for home health services if you have original Medicare. For durable medical equipment, there is a co-pay of 20% of the Medicare-approved amount (such as wheelchairs, hospital beds, crutches, walkers, kidney machines, ventilators, oxygen, monitors, and pressure mattresses).
Before beginning home health care, consult with your agency to determine what costs will be spent and which will be paid by Medicare. They’ll also let you know if there are any services that Medicare doesn’t cover. This should be stated both verbally and in writing, and you will be given a “Advance Beneficiary Notice” before receiving any non-Medicare treatments.
Your home health agency may submit a per-claim review request to Medicare in select states (including Florida, Michigan, Illinois, Massachusetts, and Texas). This is beneficial to both you and the agency since you will know whether Medicare will fund the services.
The amount you owe for non-Medicare covered services is determined by the following factors: • Any other medical insurance you have.
- The fees charged by your doctor.
- If your doctor agrees to take on the assignment.
- The kind of treatment center.
- The location where you obtain your tests or services.
In rare situations, your doctor may propose a treatment plan that needs more frequent treatments than Medicare covers, or therapies that are not covered. You will be responsible for the charges if this occurs, so ask questions to understand why they are being advised and what costs you would have to pay out of pocket.
Is skilled nursing care included in the plan?
Intermittent (or part-time) nursing services are covered by Medicare. This means that nursing care is provided for no more than seven days per week or for no more than eight hours per day, up to a maximum of 21 days. In some situations, Medicare will extend the time limit if your doctor can accurately predict when your care would conclude.
In most cases, skilled nursing services are used to treat a sickness or support a patient in recovering from an injury. To give the medical therapy you require, the nurse must be licensed (such as wound dressing, injections, and catheter changes).
What types of home health services do aides provide?
If you require assistance with daily activities such as dressing, bathing, or going to the bathroom as a result of an injury or illness, home health aides can help. Medicare will only pay for them if you also receive professional nursing or therapy.
When does Medicare fund physical, occupational, or speech therapy?
When physical therapy is used to help a patient regain strength or mobility following an illness or injury, Medicare will pay for it. The same is true for occupational therapy, which aims to restore functionality, and speech therapy, which aims to teach patients how to communicate again.
The services will only be covered if they are projected to improve the situation within a reasonable time frame. Furthermore, the frequency, duration, and number of services must be acceptable, and they must be offered by a licensed therapist.
Your condition must either:
- Be expected to improve,
- Require a maintenance program from a professional therapist, or
- Require a skilled therapist for maintenance to be eligible for the services.
Following an illness or accident, professional therapists will restore or increase your capacity to perform basic daily tasks, communicate, and even walk.
They may also assist prevent a condition from worsening, but they will only be covered if the services are used to treat your disease specifically, safely, and efficiently.
What types of durable medical equipment does Medicare cover?
Medicare will reimburse the cost of durable equipment if it is essential and prescribed by a doctor for use at home.
- Wheelchairs (electric or manual).
- Canes or walkers are among the durable medical devices that are covered.
- Hospital beds are available.
- Oxygen.
- Nebulizers.
- Blood glucose monitoring
You are responsible for the remaining deductible under Part B, as well as 20% of the Medicare-approved value for the equipment.
What is the definition of medical social services?
These are medically prescribed treatments that assist patients in dealing with the emotional repercussions of illness or disease. In-home counseling by a licensed therapist or social worker is an example of medical social services that Medicare covers. Keep in mind that Medicare only pays for these services if you receive competent nursing care at home. If you require assistance, they can also assist you in locating community services.