Home health care is covered by Medicare. Part A or Part B, depending on the circumstances, offers coverage. Beneficiaries do, however, fulfill such requirements.
Where it is necessary, home health means assisting an individual in receiving treatment in their own home rather than in a hospital.
In certain cases, home health care is less expensive and just as good as care received in a hospital when it is appropriate. In certain cases, home health care is less expensive and just as good as care received in a skilled nursing facility (SNF) or a hospital. A Medicare-certified home health provider must offer the service for Medicare to pay for it.
In this post, we’ll go over how Medicare covers home health services.
In this article, we’ll use a few words that are important to know when choosing the right insurance plan:
• Deductible: A deductible is a certain sum that an individual must pay out of pocket per year until an insurer can pay for their treatments.
• Coinsurance: A portion of a treatment’s expense that must be covered by the patient. This amounts to 20% for Medicare Part B.
• Copayment: A copayment is a set fee that a covered individual must pay while undergoing such treatments. Prescription medications are normally covered by Medicare.
What resources does Medicare provide for in-home care?
Rehabilitation therapy and skilled nursing services may be available to people with Medicare Part A.
Various home health facilities are covered by Medicare for as long as they are reasonable and considered sufficient to treat an accident or illness.
Medicare pays for up to 8 hours of service a day, up to a total of 28 hours a week. The insurance policy covers up to 35 hours of home health care a week for certain individuals. On a case-by-case basis, Medicare evaluates the need for 35 weekly hours of treatment.
The following programs are covered by Medicare:
Rehabilitation therapy is a type of treatment that is used
Rehabilitation programs assist an individual in regaining everyday function and increasing their ability to live independently on a daily basis.
Physical, occupational, and speech therapy are examples of these programs.
Medical equipment and materials
Part B of Medicare includes certain medical supplies that are needed for home health care. For Medicare to cover the equipment, it must be prescribed by a doctor.
Medicare can cover the following medical supplies and equipment:
- infusion pumps
- hospital beds
- blood sugar testing strips and monitors
- nebulizer equipment
- traction equipment
- wound dressings and supplies
Depending on the type of supplies or facilities, Medicare covers the cost of medical equipment for home use in a few different ways.
Medicare, for example, would cover the cost of renting those forms of equipment. Patients may opt to purchase the equipment themselves, in which case Medicare would cover the expense as well.
Community and medical programs
A social worker or counselor can assist you with these programs. They will assist people in dealing with emotional problems that are preventing them from fully recovering from an illness or injury.
Nursing treatment provided by professionals
Part A of Medicare also includes skilled nursing services provided by home health whether it is sporadic or part-time.
Intermittent nursing entails providing treatment for less than 8 hours a day for 21 days or up to 35 days in some cases. It may also apply to nursing care given on less than seven days a week.
Professional nursing treatment that lasts longer than 8 hours a day or is not sporadic is not covered by Medicare.
For Medicare to pay for home health services, a registered nurse or licensed practical nurse must provide professional nursing. The following types of skilled nursing services can be given in the home:
- wound care and dressing changes
- tube feedings
- administering intravenous (IV) drugs
- education in disease management
Home health personal care
Personal treatment, such as dressing and bathing, is provided by home health aides.
When an individual needs skilled nursing care or recovery services by home health, Medicare only pays for a personal care aide. Home health personal care assistants are not covered by Medicare as a stand-alone program.
There are several exceptions.
Both home health services are not covered by Medicare.
- Meal delivery is not included.
- personal care, such as washing, without the need for professional nursing care
- household facilities, such as cleaning and shopping
- In-home treatment available 24 hours a day, 7 days a week
Certain services, such as foot care, are also not covered by Medicare, regardless of whether they are provided in the home.
Criteria for eligibility
Medicare Part A and Part B recipients are eligible for home health care if they meet certain requirements.
To be eligible for services, you must meet the following criteria:
- Individuals must qualify for Medicare parts A and B.
- The treating doctor must certify that the beneficiary needs one or more of the following: physical therapy, occupational therapy, speech therapy, or intermittent nursing care.
- A Medicare-approved home health agency must provide the care.
- Skilled nursing care is only intermittent or part-time.
- The beneficiary cannot leave their home.
The beneficiary’s treating doctor certifies that he or she is housebound. Owing to an accident or disease, being homebound means not being able to leave the house without a wheelchair, walker, or special transportation.
Medicare will deem a person homebound if a doctor advises that they stay at home due to a medical condition.
Expenses paid out of pocket
Home health facilities are free for those with Original Medicare. There are no copayments or deductibles for home healthcare, unlike inpatient hospital stays.
However, there is one exception. Medicare beneficiaries pay 20% of the Medicare-approved expense for medical equipment and supplies such as a wheelchair, cane, or walker.
For any given time, Medicare only provides coverage from one Medicare-approved home health agency. It does not cover services provided by two or more different home health providers at the same time.
A home health agency usually tells the recipient of how much Medicare will cover and how much they will have to pay before they begin treatment.
This ensures that Medicare applicants are aware of their out-of-pocket costs and obligations prior to receiving services.
The Advance Beneficiary Notice is a verbal and written clarification of costs provided by the home health agency. In certain states, a home health agency may ask for a Medicare review to ensure that programs are covered. This notice allows both the agency and Medicare beneficiary to confirm coverage and set expectations early on in the process.