Paying for home health care is of major concern to many seniors and their families who don’t have a long-term care insurance policy or ample financial resources to pay out-of-pocket for home health care expenses. Fortunately, Medicare does pay some home health care costs under certain conditions.
To be covered, the services provided must be ordered by a doctor, and a Medicare-certified home health agency must provide the care. If these stipulations are followed, Medicare can pay the full cost of home health care for up to 60 days at a time. The 60-day periods are renewable and will be approved by Medicare if your doctor recertifies at least once every 60 days that your care is still medically necessary.
Qualifying For Home Health Coverage
To qualify for Medicare home health benefits, the following conditions must be met:
You are homebound
This means you’re unable to leave your home without considerable effort, without the aid of another person, or without using a device such as a walker or a wheelchair.
You have been certified by a doctor
You need to be certified by a doctor or another medical professional working directly with a doctor (such as a nurse practitioner) as needing intermittent occupational therapy, physical therapy, skilled nursing care, and/or speech-language therapy.
Certification Authentication
Certification arises from a documented, face-to-face visit with the medical professional no more than 90 days before or 30 days after the start of receiving home health care.
You are under a care plan
This means that a doctor established and reviews regularly. The plan should include what services you need, how often you’ll receive them, who will provide them, what supplies are required, and what results in the doctor expects.
Medicare has approved
Approval from medicare of the home health agency you’re working with.
Range of Home Health Benefits
Depending upon the service being received, original Medicare Part A (hospital insurance) and/or Part B (doctor visits and outpatient treatment) — might cover home health care. Services include:
Skilled nursing care
includes changing wound dressings, feeding through a tube, and injecting medicine, and is provided on a part-time or intermittent basis. Your combined home nursing and personal care cannot exceed eight hours a day or 28 hours a week, except in limited circumstances. If you need full-time or long-term nursing care, you probably will not qualify for home health benefits.
Home health aides
to assist with personal activities such as bathing, dressing, or going to the bathroom if such help is necessary because of your illness or injury. Medicare covers these services when you are skilled at nursing or therapy.
Occupational, physical, and speech therapy
with professional therapists to restore or improve your ability to perform everyday tasks, speak or walk in the aftermath of an illness or injury, or help keep your condition from getting worse.
Medical social services
such as counseling for social or emotional concerns related to your illness or injury if you’re receiving skilled care and help to find community resources if you need them.
Medical supplies
such as catheters and wound dressings related to your condition when your home health agency provides them. This might also include durable medical equipment from the home health agency, such as walkers or wheelchairs, but Medicare does not pay the full cost for those. You usually are responsible for 20 percent of the Medicare-approved amount.
Medicare does not cover:
- 24-hour care at home
- Custodial or personal care when this is the only home care you need.
- Household services such as shopping, cleaning, and laundry when are not related to your care plan.
- Meal delivery to your home
Assisting Hands Home Care of Boston Northwest can help. We work in tandem with your health care providers by providing non-medical assistance to seniors and others who want to remain independent, safe, and comfortable where they prefer to be most – the comfort of their own homes. If you are seeking care for yourself or your loved one living in Bedford, Winchester, Concord Massachusetts, or throughout the Northwest Boston area you can contact us.
Call us today at (781) 797-3299 with any questions you have about our services or to arrange a free in-home consultation. We’ll be happy to put together a personalized care plan for you or your loved one.
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