The home health industry is worth around 281 billion dollars and growing. Aging populations are looking for more options to age in place rather than go to nursing homes or assisted living facilities.
If you have Medicare, your home health services may be covered under your plan. Take a look at these 7 tips for getting home health care services through Medicare.
- Homebound Certification
In order to qualify for home health benefits through Medicare, a doctor must certify that you are homebound. Being homebound means that you have trouble leaving your house with the help of a cane, wheelchair, walker or crutches.
Homebound seniors might also need special transportation because of an injury or illness. Check with your doctor to learn whether you meet these criteria for being homebound.
- Part-Time Nursing Care
Home health care services are for seniors who need part-time nursing care. If you need full-time support, you won’t qualify under your Medical billing and insurance plan.
Nursing care can be any of the following:
- Physical therapy
- Speech-language pathology
- Occupational therapy
Any of these are covered as long as the home environment is safe and considered effective for your treatment. Medicare will only approve a certain frequency and length of treatment.
Healthcare services provided by nursing staff should be complex enough to require the help of a trained professional. Medicare measures this by how quickly you recover from illness or injury and whether this condition usually requires supervised medical attention.
You need to be under the care of a doctor who can make the recommendation for you to see a specialist ongoing. This same doctor should measure the results of your treatment in order for your plan to cover the services you receive.
- Original Medicare Pays Nothing
If you have an original Medicare plan, you usually don’t pay anything for home health care services. There may be a 20 percent copay to cover the cost of any durable medical equipment.
These costs vary per plan so you’ll need to follow up to determine your payment responsibilities for the equipment and resources needed to provide your care. In-home help from trained medical professionals is included with your plan.
Often, the home health care agency can advise which services are included with your Medicare plan. They’ll recommend services based on your plan and you can opt to upgrade and pay out of pocket if you need additional resources.
Any home health care agency should notify you of all costs in writing before starting your treatment plan.
- Do You Really Need Home Care?
The biggest difference between home care agencies and home health care agencies is medical training. If you are looking for help with things like eating, cleaning or getting dressed, you might need a home care agency.
These non-skilled home care workers provide you with support in activities of daily living (ADLs). Home care workers can also help with smaller medical tasks like taking insulin or medication that most people do on their own.
- Custodial Service Options
Low-income adults can opt to add to their home health care services under Medicaid. Medicaid services are handled by your state government which has varying income criteria.
If you qualify, you’ll have access to programs like adult daycare, assistance with household chores or homemaker services to supplement your medical care.
- Home Health Care Services are Temporary
Home health care services are meant to be temporary. As you recover from a specific injury or illness, your doctor might recommend home health care to help speed up your recovery process.
The goal is to help you regain your independence so that you can resume life as normal. In some cases, the home health care professional is looking to maintain your condition so it doesn’t get worse.
These situations can make home health care through Medicare much more affordable than if you got extended care services on your own. It might be possible to get Medigap insurance for the amount of extended coverage that Medicare refuses to pay.
- Enrolling in Medicare
Enrolling in Medicare is automatic for most seniors when they reach the age of 65. If you don’t get enrolled automatically, you can sign up at your local social security office.
People who don’t receive social security benefits won’t usually get automatic enrollment in Medicare. This could happen if you didn’t maintain full-time employment or were a homemaker throughout your life.
Time your enrollment so that your benefits are instantly available on your 65th birthday. Start the application process around 2 or 3 months before you turn 65 for prompt coverage.
After a 60 day waiting period, you can get Medicare-certified home health care services that are covered in the insurance plan you select. The amount paid towards your services varies based on your medical condition.
In general, choosing a certified agency is the best way to reduce out of pocket costs.
Using Medicare for Home Health
Home health care services are a temporary solution to help you avoid worsening an injury or illness. You can have up to 100 percent of your home health costs covered if you have an original Medicare plan.
The more equipment you need for treatment, the more you should expect to pay out of pocket for services. Basic in-home health care like speech therapy will be cheaper because you don’t need equipment ongoing.
Unfortunately, Medicare’s coverage for home health care services is limited to the staff itself. If you need additional support getting to and from doctor’s visits, you have to cover this special transportation yourself.
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