Will Medicare Cover Home Health Care?
The same procedures and treatments that once had to be performed at a doctor’s office can now be done at a patients home. Home health care is giving patients more options and control.
Home health care is often confused with home care (also called home health aide, homemaker services, or personal care), but they are different.
Home health care includes treatments from a licensed nurse or therapist. Skilled nursing services can include shots, wound care, prescription drug adherence, and diabetes care. Therapy services include rehabilitation after injury/illness, physical therapy, occupational, and speech-language pathology services.
Home care services make your life easier but aren’t a medical necessity. These services can include: meal deliveries, transportation, hygiene care, help bathing, or adult baby sitting. They are services that a person who isn’t licensed can give you. Medicare does not cover home care services unless you also qualify for skilled services.
Medicare will cover home health care services if you meet these 4 criteria:
1. Your doctor orders that you need skilled nursing services.
You must have a doctor’s referral or order to get skilled services at home. The doctor and home health care agency decide a plan of care based on your needs and illness/injury. Home care services are only covered if they are part of your care for injury or illness.
Your doctor ordered that you need therapy services.
The sessions must be hard enough that you need a therapist to monitor you and your improvement. Therapy services should either restore functions or prevent your condition from getting worse.
2. You need part-time skilled services.
If you full time care, medicare rarely covers these services.
3. You’re homebound.
You must have difficulty leaving your house due to health, injury, or handicap then you probably qualify as homebound. Homebound does not mean bed ridden or that you can’t leave the house, though.
4. The home health care agency you choose is Medicare certified.
Make sure to check whether the agency you want to use is Medicare certified. Medicare will only cover agencies that have been certified through them.
If you qualify, Medicare fully covers home health care. This includes the visits and basic medical equipment (bandages, IV bags, etc.).
Medicare covers 80% of medical equipment. If you need a wheel chair, oxygen equipment, or other large medical equipment, you will pay for 20% of the cost.
Home health care is designed to help you get back on your feet and gain your independence back. If you will use Medicare to cover you home health care, check with your doctor and agency to find out exactly what services you will receive and what you will be expected to pay for.
If you want more information on what medicare will or will not cover, check out their page here: https://www.medicare.gov/Pubs/pdf/10969-Medicare-and-Home-Health-Care.pdf
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