Who is qualified for Medicare covered home care services?
Medicare covers some of the expenses you incur from your home health care, but the size of this coverage has been over-exaggerated beyond the services they literally cover. Hence, resulting in a vast misconception that will make people pay for some health services, they thought Medicaid would cover in the long run.
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You can avoid the result that comes from being ignorant of the essential health care services that are covered by Medicare if you are aware of the full relationship between Medicare and home health care services and the eligibility requirements to enjoy the benefits that come from it.
What does Medicare cover?
Home health care includes the personal and medical care provided at the comfort of your home for the treatment of mild to severe types of illnesses and injuries you are suffering from. The expenses you incur may be covered by a Medicare health insurance program, primarily Medicare Part A and Medicare Part B, which are hospitals insurance and medical insurance, respectively, only if you are eligible for the offer. These parts of Medicare insurance (either Medicare part A or Medicare part B) will cover a variety of home health care services that include physical therapy, medical social services, occupational therapy, part-time or routinely skilled nursing care, speech-language pathology services, personal hands-on care (part-time or intermittent home health aide services) and injectible osteoporosis medications for women.
Medicare Part A or Medicare Part B does not offer coverage for expenses that originate from the following factors
– Medicare does not pay for homemaker services if that is the only service you need. These services include laundry, shopping, and home maintenance to retain the aesthetic and structural integrity of your home.
– Medicare does not cover the expenses of your personal care if that is the only service you need. These services include bathing, dressing, and using the bathroom.
– They do not pay for full time (24 hours per day) home care services
– They also do not cover the expenses that come from the meal deliveries.
Eligibility requirements for Medicare coverage of home care services
Being insured by either Medicare Part A (hospital insurance) or Medicare Part B (medical insurance) does not necessarily guarantee or make you eligible for the benefits of expenses coverage on several home care services such as speech-language pathology services, physical therapy, and other services stated earlier. Because there are several other requirements, you must meet apart from been insured by Medicare to make you eligible for expenses coverage by Medicare. The other requirements include the following:
– You must be unable to leave your home without getting help from someone or devices. You must be homebound (a doctor must certify that you are homebound).
– Your medical condition must be attended to by a particular health care specialist who will create your medical plan and also review them at intervals.
– Your doctor must certify that your medical condition requires skilled nursing services or professional therapy care at intervals to harness and treat your medical condition.
– If you need Home health care services such as speech-language pathology services, continued occupational services, or physical therapy. However, it must be specific, safe, and requires effective treatment.
– Your medical condition must be so severe that only a qualified therapist or health care specialists can treat it safely and effectively
– Your medical condition must have a predictable and reasonable recovery time.
– The home health agency offering you care must be approved by Medicare
If your medical conditions require 24 hours per day attention instead of part-time or routine nursing care, and also, if you do not qualify for the eligibility requirements stated above, you will not be eligible for home health care benefits with Medicare coverages for all incurred expenses. Furthermore, if you only need continued occupational services, you will not qualify for Medicare. But you can be a beneficiary of occupational services if you qualify for home health care on another basis.
What will Medicare cover if you are qualified for home care benefits?
If you are qualified for home health benefits, Medicare will cover the following
– Skilled therapy services
– Skilled nursing services
– Home health aide
– Medical supplies
– Durable medical pieces of equipment
Skilled therapy services: Medicare covers professional therapy services that comprise physical, occupational, and speech therapy for the treatment of your medical condition under the supervision of a licensed and qualified therapist. Physical therapy includes gait and fitness training primarily who lose their ability to several parts of their body. Speech-language pathology services are primarily a therapy exercise for the restoration and strengthening of speech loss and language skills. Occupational therapy will help you regain the strength to perform your daily activities such as eating and wearing clothes.
Skilled nursing services: Medicare covers nursing services that may include injections, catheter changes, tube feeding, and wound care. However, these services are performed under the supervision of a qualified and licensed nurse for the treatment of your medical conditions for not more than twenty-eight hours per week.
Home health aide: Medicare will pay for personal care only if you also require skilled care. Medicare will not cover personal care, such as bathing and dressing, if you do not need skilled nursing or therapy services.
Medical supplies: Medicare will provide coverage for the expenses of several medical supplies such as wound dressings, but this is possible only if your home care agency is Medicare-approved.
Durable medical equipment (DME): Medicare provides eighty percent coverage on the standard or approved expenses for several pieces of medical equipment you will need for the improvement of your health, such as a wheelchair.
In as much as you are qualified for home health care benefits, Medicare will provide coverage for the following listed services, be it mild or chronic medical conditions. Although, in some cases, doctors may recommend some services that will not be covered by Medicare.
All home health care agencies usually inform individuals about the several services that will be covered by Medicare and the amount you will be obligated to pay for items or services Medicare does not cover. But they will give you an Advanced Beneficiary Notice (ABN) before informing you about the services that Medicare will not cover.
