Health care at home can be an answer to this as one begins to age or has a medical condition that makes it difficult to leave the house. Medicare is a program that assists people in covering health care costs, particularly when they are over 65 and dealing with disabilities. But there is a question that begs to be answered: Does Medicare pay for home health care? Yes, you can — learn about what services are covered and when constraints must be met.
Let’s First Know What is Home Health Care?
For example, home health care is when you receive health services at home instead of a hospital or doctor’s office. It can range from assistance in some daily activities to nursing care and therapy services. This type of care can be particularly useful for individuals who are homebound, and unable to leave their homes without assistance.
Patients might need home health care during recuperation from surgery or a long-term illness, or to manage their quality of life in home settings. It can also provide peace of mind to family members that their loved ones can be cared for without needing to go into a care home.
What Does Home Health Care Covered by Medicare?
Medicare covers some home health services, but only in certain conditions. Let’s break it down:
Skilled Nursing Care
That type of care could include wound dressing, administering injections, and medication management by licensed nurses (nursing care). However, this kind of care is very often needed by patients recovering from surgery, injury or a major illness.
Skilled nursing care that’s required on a daily basis and as part of a treatment plan prescribed by a doctor is covered by Medicare. Services must be provided by a Registered Nurse or Licensed Practical Nurse. However, Medicare will not help with full-time care; it only pays for some intermittent or part-time home health aide care.
Physiotherapy, Speech and Language Pathologist, Occupational therapy
If therapy services are necessary for improving a patient’s condition, Medicare will pay for them. For example:
We also use physical therapy when a patient cannot walk from their bed to the bathroom following a stroke.
It can be used in people with speaking or swallowing difficulties as a result of injury or medical condition.
Occupational Therapy: Assists individuals with learning or re-learning how to perform daily tasks, i.e. wearing clothes, eating etc.
These services must be ordered by a doctor and those services should care for the patient’s treatment plan just like skilled nursing care.
Home Health Aide Services
In these circumstances, Medicare may also pay for a home health aide if the person needs this type of assistance in addition to skilled nursing care or therapy services. Home health aides help with daily personal care needs, such as bathing, dressing or using the bathroom. ACA Coverage: Home health care provided in the home by a non-medical provider Medicare Coverage: Home health aide services and skilled care within the scope of limitations. The patient must also require skilled medical care.
Medical Social Services
If you have trouble coping with emotional or social problems your illness brings on, medical social workers can provide assistance. Medicare will pay for medical social services only if you meet the criteria for these services and they are part of your home health care plan. Which may include counselling, community resource acquisition, or help with long-term care planning.
Medical, Medical Supplies, Medical Equipment
When a patient is enrolled in home health care, Medicare covers certain medical supplies and equipment. Or, it might cover expenses such as bandages, catheters and wound care supplies. It also incorporates DME (durable medical equipment) such as wheelchairs, walkers or oxygen equipment that is essential for the health condition of the patient.
Here Is What Medicare Does Not Cover for Home Health Care
Although Medicare pays for many home healthcare services, it does not cover all services. Here’s what it won’t pay for:
- Round-the-clock care: Medicare will not pay for 24-hour-per-day help if that is the only type of care you need.
- Delivery of meals: Opting for a meal prep or delivery service and need assistance, Medicare does not cover this.
- Homemaker services: This is help with household tasks, such as cleaning or laundry that are not covered if the person also needs skilled medical care in order to obtain them.
- Personal care only: Medicare won’t pay for personal care like help bathing or dressing if that is the only service needed.
Does Medicare Pay for Home Health Care?
Patient Requirements to be eligible for Medicare home health care coverage:
Homebound: The patient is unable to leave the home and needs help or a device (e.g., a wheelchair) to do so. A homebound status does not mean a person can never leave their home, but rather that if they do leave the home, it is infrequently and often for medical reasons.
Skilled care: The patient requires skilled nursing care or therapy services, and the order must be made under doctors. The care must be given in connection with a doctor-ordered treatment plan that the physician will periodically review.
Must be from a Medicare-certified home health agency: Many home health agencies that send patient CAREGivers to clients’ homes may not be certified by CMS. Services must be furnished by an agency that meets Medicare requirements for home health aides
How Much Home Health Coverage Will Medicare Pay For?
Medicare will break down the home health care into benefit periods, that start from the first day that their criteria are met and continue until they end, but Medicare does not limit how long it covers your home health care. Medicare will pay for services as long as they are medically necessary. Another example occurs when the clinically appropriate therapies do not see progress towards discharge or improvement for a while. Which may result in Medicare holding payment and/ or ceasing covering the service.
Medicare often assesses the necessity of ongoing treatment every 60 days. But, if the patient is still in need of care and meets eligibility criteria, coverage can be prolonged.
Home Health Care Guidelines for Medicare
The best thing to do, if someone believes they might require home health care, is to talk to their doctor. A doctor will assess the patient and decide whether home health care is needed. If it is, the doctor will write a treatment plan that includes what services are required.
Then, the patient will have to pick a Medicare-certified home health agency. The doctor or hospital discharge planner can probably assist in finding one. Home health agency The patient and doctor agree on care; the home health agency has to work with them.
Read more: Which Medicare Advantage Plan Has the Best Dental Coverage
Conclusion
Although people may need professional medical care, that does not mean they must be separated from their homes. Medicare reimburses you to be able to receive a variety of home health care services from skilled nursing treatment, physical therapy (PT). Speech-language pathologists (SLPs), and occupational therapy (OT) to some helpful personal care solutions. However, there are strict guidelines as to who is eligible for the program and what types of services it covers.
Patients and families can be better able to decide on their own treatment. Making sure they are looked after properly at home in the process when those principles are known. If you are not sure whether you or your loved one is eligible for home health care from Medicare, contact a doctor to get the process started.
