Medicare Home Health

First of all you or your loved one may be new to the world of Medicare, so what is it? Medicare is the federal health insurance program for people who are 65 years or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD – permanent kidney failure requiring dialysis or a transplant). There are four different parts of Medicare: Part A, Part B, Part C, and Part D. The different parts of Medicare help to cover specific services.

• Medicare Part A (Hospital Insurance)
  • This part will cover inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
• Medicare Part B (Medical Insurance)
  • This part covers certain doctors’ services, outpatient care, medical supplies, and preventive services.

• Medicare Part C (Medicare Advantage Plans)
  • This part is a type of health plan that is offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. These plans include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. Most of these plans offer prescription drug coverage.
• Medicare Part D (Prescription Drug Coverage)
  • This part adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans. These plans are offered by insurance companies and other private companies approved by Medicare.

There are 4 criteria an individual must meet in order for Medicare to help cover costs of your home care services:

1. You must be considered homebound. This means that you either require the assistance of another person or device (walker) to leave your home, your provider believes that if you leave your home it would be harmful to your health, and it is difficult for you to leave your home and you generally are not able to do so.
2. You require skilled care.
3. Your doctor signs a home health certification stating that you qualify for Medicare home care due to being homebound and in need of intermittent skilled care. The certification must also say that a plan of care has been made for you, and that a doctor regularly will review and evaluate it.
4. You receive your care from a Medicare-certified home health agency (HHA).

Following the brief explanation of Medicare above, you or your loved one should now have a better understanding of how it works and what services are covered. As far as home health services go, Medicare will cover specific types of care. The programs offered by Total Home Health will be specific to you not only regarding your situation, but also your Medicare benefits. If you qualify for the home health benefit, you will find that Medicare covers the following types of care:

• Skilled nursing services and home health services provided up to 7 days a week for up to 8 hours per day or up to 28 hours per week. In the event of an unusual case, Medicare can cover up to 35 hours (an unusual case will be determined by other rules and regulations).

• Medicare will pay in full for skilled nursing care. This includes services and care that can only be performed safely and effectively by a licensed nurse. Such as injections, tube feedings, catheter changes, observation and assessment of a patient’s condition, management and evaluation of a patient’s care plan, and wound care.

• Medicare will pay in full for a home health aide if you require skilled services. This aide will provide personal care services including help with bathing, using the bathroom, and dressing. If you only require this type of personal care, you indeed do not qualify for the Medicare home care benefits.

• Skilled therapy services. Physical therapy (PT), speech therapy (ST) and occupational therapy (OT) services that can only be performed safely by or under the supervision of a licensed therapist, and that are reasonable and necessary for treating your illness or injury. PT includes gait training and supervision of and training for exercises to regain movement and strength to a body area(s). ST services include exercises to regain and strengthen speech and language skills. OT helps you regain the ability to do usual daily activities by yourself, such as eating and dressing yourself. Medicare should pay for therapy services to maintain your condition and prevent you from worsening as long as these services require the skill or supervision of a licensed therapist, regardless of your potential to improve. *There may be additional stipulations if you only require OT, Medicare benefits will be determined based on your specific condition.

• More skilled therapy services such as medical social services. Medicare will pay in full for services ordered by your provider to reach out and help you with any social and emotional concerns that you may have related to your illness. This could include counseling or help with finding resources within your community.

• Medical supplies. Medicare will pay in full for certain medical supplies provided by the Medicare-certified home health agency. This could include things such as wound dressings and catheters that may be needed for your care.

• Durable medical equipment. Medicare pays 80 percent of its approved amount for certain pieces of medical equipment, such as a walker or wheelchair.

Get busy! Do some research to see what your benefits qualify you for and enroll in Total Home Health today! Our professionals are eager to come to you and become involved in your treatment to maintain your optimal health status.