Does Medicare Cover Home Health Care?

By Shannon Martin (reprinted with permission)

Nothing is more discomforting than not knowing if you or a loved one will receive the adequate care for a full and safe recovery after hospitalization.  Neither Medicare nor traditional medical insurance cover many of the home care services that can help reduce otherwise preventable injuries and hospital re-admissions. These services, usually referred to as long term care, or “custodial care,” include companion services, general supervision for health and safety and long term home help with personal care and hygiene, meal preparation, transportation and errands.

Seniors, especially, require a variety of support services for a safe and full recovery after being discharged from a hospital.  Without the proper care, the patient often suffers preventable incidents resulting in additional and more costly care needs and reduction in independence.

Medicare does cover some home health care, when the patient meets all of the following conditions:

  • The patient must be home-bound and under a doctor’s care.
  • The patient must need skilled nursing care, or occupational, physical or speech therapy, on at least an intermittent basis (that is, regularly but not continuously).
  • The services provided must be under a doctor’s supervision and performed as part of a home health care plan written specifically for that patient.
  • The patient must be eligible for the Medicare program and the services ordered must be “medically reasonable and necessary”.
  • The home health care agency providing the services must be certified by the Medicare program.
  • Additionally, a recovering patient undergoing therapy must show continual improvement in order for Medicare to cover their home health care.

If the patient doesn’t meet strict guidelines, Medicare considers the home care custodial. At that point, when often faced with a major change in their needs due to the incident or illness that occurred, the patient becomes responsible for the cost of care.

This is where a private-duty home healthcare agency can be of great assistance. Private-duty services are designed to pick up where Medicare and other entities’ services leave off, ensuring your loved one’s continued wellbeing and independence. Sometimes a little bit of help from home caregivers can provide an alternative to assisted living or a nursing home. Home health aides can provide clients with support while they recuperate, whether it means coming in throughout the week to provide housekeeping and transportation, or staying with someone around the clock after surgery. While the client receives therapy or skilled nursing services, these caregivers can assist as the person regains strength, ensuring proper nutrition and medication compliance so that the other services received have the chance to really work.

4/1/11: Additional Requirements for Medicare Home Health
The Centers for Medicare & Medicaid Services (CMS) began enforcing new admissions requirements for Medicare to cover home health services on April 1, 2011.  Patients receiving Medicare coverage for home health care must now have a face to face visit with their physician within a certain time frame to certify eligibility.  There are some more detailed requirements such as: the visit must be within 90 days prior to services starting or within 30 days after, the reason for the visit must relate to the need for in home care and the physician must be the same one that is managing the patient’s care plan (though hospitalists have been included as allowed under this requirement).

This new regulation intends to ensure better physician involvement and oversight, but also creates some challenges for patients.  To be eligible for Medicare to cover home health care, a person must be “homebound”, which means it is a taxing effort and challenging for them to get out to appointments.  Many eligible patients no longer drive.

If you encounter this concern for yourself or someone you care about, private duty home care services or other senior transportation services may be available to help with getting out to appointments.  A home care company can provide a home health aide to accompany an individual to appointments, providing help getting in and out of the car, walking safely and helping with any personal needs during the trip.  If you do not know of such companies in your area, ask the Medicare home health agency if they can provide a list, contact your local Area Agency on Aging and read 5 Tips for Choosing a Quality Home Care Provider.  You local Area Agency on Aging (www.eldercare.gov) should be able to provide information on community senior transportation options as well and may have information on any visiting physician services available in your community as another alternative for the homebound.

This article was previously published on www.eCareDiary.com, a leading website for caregivers of aging loved ones.  The site offers free tools, articles, video & radio shows on all eldercare & caregiving topics. Visit our Blogs page for more relevant articles.

Shannon Martin, M.S.W., CMC, is Director of Communications at Aging Wisely, LLC (http://www.agingwisely.com), a professional care management and patient advocacy organization and EasyLiving, Inc. (www.easylivingfl.com), a licensed home care agency, in Clearwater, FL.  Shannon serves as adjunct professor at Eckerd College in St. Petersburg, FL, where she created a course on “Eldercare”.  Prior in her career, Shannon served as social services director and admissions coordinator in an assisted living/skilled nursing facility and worked as a social worker and volunteer coordinator for a large hospice.

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