Medicare

Medicare pays 100% of Home Health services if the four following requirements are met:

• Orders are obtained from your doctor.
• Patient requires at least one of the following skilled services intermittently: Nursing, Physical Therapy, Speech Therapy, or continued Occupational Therapy
• Homebound requirement is met.  (Very strenuous and/or patient needs help from others to get to appointments or activities.)
• The home health agency is Medicare approved.

 

Services Medicare Covers:

Skilled Nursing on an intermittent basis for areas of: wound care, medication management, and any other service that requires the skills of a registered nurse or LPN.

Home Health Aide for personal care needs.  Medicare will not cover aide services if skilled services are not required.

Physical Therapy for rehabilitation after surgery, teaching assistive devices, improving gait and balance to prevent falls.

Speech Language Pathology for stroke and dysphasia patients.

Occupational Therapy to teach assistive devices and ensure living area is safe.

Medical Social Services to counsel and find community resources to improve social and emotional problems that affect the health condition of the patient.

Medical Supplies will be covered in some instances if they are related to the current problem that home health is involved with.  This does not include medications.

Medical Equipment is usually covered at 80% for those devices needed for health reasons, like wheelchairs.

Medicare Does Not Cover the Following:

• 24 hour a day care.
• Prescription medications
• Homemaking services including: shopping, delivering meals, cleaning, laundry, and errands.
• Personal care when a skilled service is not required.

These services are available through private-pay contracts, Medicaid, and other insurance.  Check your community resources for more information.

What to Expect After Choosing a Home Health Agency

A nurse will come to your home to do an assessment and ask questions about your medical history.  From this information a plan of care will be developed with you and your physician.  The plan of care will include the services you will receive (nursing, physical therapy, aide, etc.) how often, and your goals for improvement.

Your goals are very important.  They will determine the amount of time you require Home Health services.  If you cannot physically meet your goals, or make progress in that direction, Medicare will not pay for further services.  Other options or services might be needed in these types of situations.  You and the Home Health agency should consult your physician about changing your plan of care or trying other services.

It’s Your Choice

You can choose to receive services from any Medicare-certified agency.  Your doctor and/or case manager should respect your decision.  If you are unhappy with the agency you have been working with, you can change at any time.  You need to let both the new and old agency know of your decision.

 

Find Out About the Home Health Agencies in Your Area By:

• Talking to your doctor
• Accessing community resources like the 55+ book arranged by Aging Services
• Looking in the phone book under “Home Health”
• Going to health fairs and community sponsored senior events

 

Your Rights

• To choose your Agency
• To be told when Medicare will not cover a service (verbally and in writing)
• To receive the services your doctor orders
• To be involved in planning care and discharges
• You cannot be denied services due to your condition unless the agency denies everyone with your condition

 

If you would like more information on this subject; please call Professional HealthCare at Home
(1-800-654-5677). Or go to www.medicare.gov, search publications for “Home Health”, or call
1-800-MEDICARE  (1-800-633-4227).