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Home care is a phrase commonly used to refer to a wide range of health and social services. These services are delivered at home to recovering, chronically or terminally ill persons or people with disabilities in need of medical, nursing, social or therapeutic treatment, and/or assistance with the essential activities of daily living.
Medicare will help pay for your home care if all four of the following are true:
1. You are considered homebound. Medicare considers you homebound if you meet the following criteria:
• You need the help of another person or special equipment (walker, wheelchair, crutches, etc.) to leave your home or your doctor believes that leaving your home would be harmful to your health; and
• It is difficult for you to leave your home and you typically cannot do so.
2. You need skilled care. This includes skilled nursing care on an intermittent basis. Intermittent means you need care as little as once every 60 days to as much as once a day for three weeks (this period can be longer if you need more care but your need for more care must be predictable and finite). This can also mean you need skilled therapy services. Skilled therapy services can be physical, speech or occupational therapy;*
3. Your doctor signs a home health certification stating that you qualify for Medicare home care because you are homebound and need intermittent skilled care. The certification must also say that a plan of care has been made for you, and that a doctor regularly reviews it. Usually, the certification and plan of care are combined in one form that is signed by your doctor and submitted to Medicare.
• As part of the certification, doctors must also confirm that they (or certain other providers, such as nurse practitioners) have had a face-to-face meeting with you related to the main reason you need home care within 90 days of starting to receive home health care or within 30 days after you have already started receiving home health care. Your doctor must specifically state that the face-to-face meeting confirmed that you are homebound and qualify for intermittent skilled care.
• The face-to-face encounter can also be done through tele health. In certain areas, Medicare will cover examinations done for you in specific places (doctors’ offices, hospitals, health clinics, skilled nursing facilities) through the use of telecommunications (such as video conferencing).
4. You receive your care from a Medicare-certified home health agency (HHA).
*If you only need occupational therapy, you will not qualify for the Medicare home health benefit. However, if you qualify for Medicare coverage of home health care on another basis, you can also get occupational therapy. Even when your other needs for Medicare home health end, you should still be able to get occupational therapy under the Medicare home health benefit if you continue to need it.
If you have questions about billing issues for home health care you should contact 1-800-MEDICARE.
If you qualify for the home health benefit, Medicare covers the following types of care:
• Skilled nursing services and home health services. Skilled nursing services and home health services provided up to seven days a week for no more than eight hours per day and 28 hours per week (Medicare can cover up to 35 hours in unusual cases).
Skilled therapy services Physical, speech and occupational therapy services that can only be performed safely by or under the supervision of a licensed therapist, and that are reasonable and necessary for treating your illness or injury
Medical social services.
Medical supplies. Medicare pays in full for certain medical supplies provided by the Medicare-certified home health agency, such as wound dressings and catheters needed for your care.
Durable medical equipment. Medicare pays 80% of its approved amount for certain pieces of medical equipment, such as a wheelchair or walker. You pay 20% coinsurance (plus up to 15% more if your home health agency does not accept “assignment”—accept the Medicare-approved amount for a service as payment in full).
To choose right Medicare Supplemental Plan, Medicare Advantage Plan OR Medicare Prescription Drug Plan, contact Sudhir Mathuria @ 713-771-2900.