What Does Medicare Cover When It Comes To Home Health Services?

The longer that we have a car, the more money that it will cost. Perhaps, it’s an issue under the hood, perhaps it’s a routine tune up or perhaps it is replacing all four tires, either way, an aging car can be costly. It is the same thing with our bodies. The older we get, the more maintenance that we will need. Perhaps, it’s a routine tune up, perhaps we might need to replace a hip, or maybe our wheels aren’t moving as fast as they used to be. So, it is important to prepare accordingly and to know what benefits are available to us to make sure that we are at our best, while spending the least. Medicare.gov put together a really great article about what is covered when it comes to care within your home:

What is covered?
Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance) cover eligible home health services like these:
-Part- Time or intermittent skilled nursing care
-Physical Therapy
-Occupational Therapy
-Speech-language pathology services
-Medical social services
-Part-time or intermittent home health aide services (personal hands-on care)

Usually, a home health care agency coordinates the services your doctor orders for you.

What is not covered?
     -24-hour-a-day care at home
     -Meals delivered to your home
     –Homemaker services
-Custodial or personal care (like bathing, dressing, or using the bathroom), when this is the only care you need. 

Who is eligible?
In order to be eligible you must have the following criteria met:
(1) You must be under the care of a doctor, and you must be getting services under a plan of care created and reviewed regularly by a doctor.
(2) You must need, and a doctor must certify that you need, one or more of these:
     -Intermittent skilled nursing care (other than drawing blood)
      -Physical therapy, speech-language pathology, or continued occupational therapy services. These services are covered only when the services         are specific, safe and an effective treatment for your condition. The amount, frequency and time period of the services needs to be
reasonable, and they need to be complex or only qualified therapists can do them safely and effectively. To be eligible, either: 1) your condition         
must be expected to improve in a reasonable and generally predictable period of time, or 2) you need a skilled therapist to safely and                       effectively make a maintenance program for your condition, or 3) you need a skilled therapist to safely and effectively do maintenance therapy         for your condition. The home health agency caring for you is approved by Medicare (Medicare certified).
(3) You must be homebound, and a doctor must certify that you’re homebound.
(4) You’re not eligible for the home health benefit if you need more than part-time or “intermittent” skilled nursing care.
(5) You may leave home for medical treatment or short, infrequent absences for non-medical reasons, like attending religious services. You can still get home health care if you attend adult day care.

What are your costs?
      – $0 for home health care services
– 20% of the Medicare- approved amount for durable medical equipment (DME)
Before you start getting your home health care, the home health agency should tell you how much Medicare will pay. The agency should also tell you if any items or services they give you aren’t covered by Medicare, and how much you’ll have to pay for them. This should be explained by both talking with you and in writing. The home health agency should give you a notice called the Advance Beneficiary Notice” (ABN) before giving you services and supplies that Medicare doesn’t cover.

If you have any questions about your specific case, feel free to contact Assured Care at (248) 262-2200. Or for more information on Medicare, click here to visit www.medicare.gov. 

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