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In this article, we’ll clarify Medicare home health care coverage for you as we address:
When you think of home healthcare, what you picture is probably spot-on: help with much needed medical services when you can’t leave your home. But if you’re homebound, how can you begin to get the care you need and make sure you’re getting the coverage you need by Medicare insurance?
Medicare has a few special rules to help get home health services to people who need them.
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First, you must have either Medicare Part A or Part B. If you are unsure whether you have them, or whether you’re able to get them, don’t worry – we can help.
Second, your doctor must determine whether you are unable to leave home without assistance, or taxing effort to do so. Talk with your doctor if you or your loved one is struggling with this; your doctor is your main advocate for setting up medical care at home.
Third, your doctor must create a plan of care which outlines both how and when you will receive specific medical services at home over a specific period of time to treat a specific condition. This plan is created by your doctor after confirming that you need of at least one of the following types of care:
Fourth, and lastly, your doctor must help to connect you with a home health agency that is approved by the Medicare program. Home health agencies are Medicare-certified organizations responsible for providing medical supplies and staff services that your doctor coordinates in your plan of care. You have a choice of which agency, as long as it is Medicare-approved.
When all four of those conditions are met, home health care can begin. But what does it truly include?
When you need medical care at home, there may be domestic or hygiene-related necessities that surround that care. Medicare can also cover these home health aide services, but what are they?
Home health aides provide unskilled custodial care to help with activities of daily living like dressing, bathing, eating, taking medications, or using the toilet. Needing assistance with these hygiene and domestic routines often comes along with complex health issues that make skilled home health care services necessary.
It’s important to know that if hygiene or domestic maintenance is the only home care you need, then Medicare will not cover it.
The plan of care made by your doctor must identify that you need care that can only be given by a skilled, licensed visiting nurse. Only then can it be coupled with custodial home health aide care.
Along the way to recovery, home care can also include certain types of medical social services. These services aid treatment and reduce recovery time such as counseling, stress management, and help finding community resources.
If you’re concerned about getting the Medicare coverage you need for home health care services, reach out to our agents at (800) 950-8060 TTY 711. We’re happy to answer all of your Medicare insurance related questions!
One of the defining features of home care services as they relate to Medicare is that they must be received fewer than 8 hours a day, over less than 7 days per week. Those hours of care cannot exceed 28 hours per week, or over a period longer than 21 days.
With that being said, if your doctor declares that you still need home health care after 21 days, then you can continue to receive it for as long as you need it.
At least once every 60 days, your doctor must make an assessment of your progress toward health goals. Any changes to your health must be reported by the visiting nurse.
These routine measures ensure medical services received at home maintain or slow the decline of an illness or injury over a reasonable period of time, typically 60 days.
But what happens when your home medical needs are more than just short-term or part-time?
Instead of focused medical treatment to improve a specific illness or injury, extended home health care helps people to stay at home while living as independently as possible; the alternative being a long-term care facility, such as a nursing home.
With long-term care, the ideal is to maintain your highest level of ability and help you learn to live with your illness or disability.
On the other hand, with short-term home care, the main goal is to get better and restore your self-sufficiency as soon as possible.
Original Medicare Parts A and B will not pay for long-term or extended home health care.
Now that we know what’s covered and what’s not, what do you actually have to pay for home health care?
With only Medicare Parts A and B, you pay $0 for home health care services, and 20% for durable medical equipment, such as an oxygen tank or wheelchair. However, you pay the full cost of long-term care.
Before starting care at home, the licensed home health agency must inform you of how much Medicare will pay, and how much you will pay, as well as any items or services that are not covered by Medicare. These costs are based on the plan of home care developed by your doctor. Just as importantly, the co-pays or co-insurance set by your Medicare health plan directly affect what you pay for durable medical equipment that you may need in order to recover. In many cases, these costs can be lower with Medicare Advantage than with Original Medicare.
If you are concerned about getting medical care or equipment needed at home, whether on a short-term or long-term basis–or especially if you’re unsure which–then a Part C plan can be an effective cost-reducing solution, even adding benefits that Medicare doesn’t include.
Part C plans, or Medicare Advantage plans, can go above and beyond what Original Medicare Parts A and B will cover. Medicare Advantage insurance can even add additional coverage for custodial care regardless of your other home health needs.
Further still, most Part C plans include your prescription drug coverage, providing an all-in-one coverage option.
To get quotes and assistance finding the right Medicare Advantage plan in your area, enter your zip code at the bottom of this page, or on our homepage. Our comparison tool is quick, easy, and costs nothing to use.