Home Health & Medicare
Posted on December 1, 2013 by bob in Medicare
Some health care once done in a hospital or doctor’s office can now be done at home. It’s just as effective, more convenient and usually less expensive. Medicare pays for health care you receive in the comfort and privacy of your home if you meet certain requirements. To qualify, you must be homebound, under a physician’s care and in need of part-time skilled nursing care or rehabilitative services.
“Homebound” doesn’t necessarily mean “bedridden.” But it does mean that you seldom leave home, except maybe for a doctor’s appointment or a worship service. And when you do, you probably require a wheelchair or walker and someone’s assistance.
Medicare pays 100 percent for your care as long as you’re eligible. It also pays for 80 percent of any medical equipment you need, like a special bed or oxygen.
One in 10 people with traditional Medicare relies on home health in any given year. About a third of the home visits are for patients released from the hospital but still requiring attention. The other two-thirds are for people trying to stay out of the hospital in the first place.
Your home health care starts with your doctor’s decision that your illness or injury demands it. You may need a skilled nurse to give you IV drugs, shots or tube feedings, or change dressings, or teach you and your caregivers about newly prescribed drugs.
You also may require rehabilitative services, like occupational, physical or speech therapy, to become as self-sufficient as possible and regain your independence.
The home health agency will work with you and your doctor to develop a plan of care. That plan will detail the services you need, how often you should have them, who will provide them, and what results your doctor expects from your treatment.
To qualify for Medicare’s home health benefit, your nursing care must be part-time. Home health aides who help with bathing and dressing, as well as homemaker aides who clean or do laundry, may be covered, but only if they’re part of your overall plan of care.
Medicare doesn’t pay for 24-hour-a-day care at home or meals delivered to your door. Nor does it cover personal care or housekeeping if that’s all you need.
Before your care begins, the home health agency should tell you about any services or items that Medicare won’t cover and how much you’ll have to pay for them. The agency should inform you about the coverage and costs both in writing and by talking with you.
You’ll want to select an agency that’s Medicare-certified. Use Medicare’s Home Health Compare website – at www.medicare.gov/homehealthcompare — to compare agencies in your area, checking on the types of services they offer and the quality of care they provide.
You’ll find, for example, statistics showing how well the patients of particular agencies recover from illnesses or injuries and resume their everyday activities.
In choosing an agency, ask your doctor, hospital discharge planner or social worker for recommendations. And visit with family and friends about their home health care experiences.
Though most home health agencies are reputable, some have been found to commit fraud. So it’s smart to know what Medicare covers and what treatment your doctor has ordered for you. If you don’t understand something in your plan of care, ask questions.
When your quarterly Medicare summary notice arrives in the mail, carefully check the statement for any services or items that you don’t think you received or used. Fraudulent billing wastes Medicare dollars and takes money that could be used to pay valid claims.
If you’re in Medicare’s traditional fee-for-service program and have questions about your home health care benefits and coverage, you can call Medicare at 1-800-633-4227. If you’re in a private Medicare Advantage plan, you should consult your plan.
Home health care can be a blessing by speeding your recovery after a hospital stay or, even better, by allowing you to avoid the hospital altogether.
Bob Moos is Southwest public affairs officer for the Centers for Medicare & Medicaid Services.
