Health professionals encourage home care for recovery when it is possible and won’t put the patient’s life in danger. Insurance companies may encourage it as well to prevent unnecessary expenses that drive up the cost of insurance for everyone.
These issues have led to an increase in the use of home health care agencies over the last decade, with seniors accounting for a significant share of these types of services. Fortunately, Medicare covers several home health services.
When Medicare covers these services
To be covered by Medicare, a situation must meet the following criteria:
- Home health services must be prescribed by a doctor.
- Part-time skilled care must be recommended instead of full-time care.
- An individual must be confined at home by an illness or injury.
- Care must be provided by an agency that is approved by Medicare.
- A health care plan must be set up by a doctor with an approved agency.
Although Medicare used to require expected improvement of a condition for approval, people may now gain approval if home care will simply maintain their condition. Medicare will not approve home health services if full-time skilled nursing care is recommended by a doctor.
What Medicare covers
Part A will pay 100% of the home care costs regardless of the number of required visits.
Additionally, the first evaluation is covered when a physician recommends it. If there was a three-day hospital stay prior to the recommendation for home services, Part A covers the costs. However, Part B covers the costs if home care is recommended without a hospital stay.
The following services are covered 100% by Medicare:
- Physical therapy
- Speech or occupational therapy
- Part-time skilled care
Care may be provided by nurses, home health aides, social services or other professionals such as occupational and speech therapists. Medical equipment and supplies that are recommended by the professionals are covered.
That said, there are several things that Medicare will not cover, including:
- Home health aide care alone,
- Home meal delivery,
- Housekeeping services,
- Drugs administered at home, and
- Full-time nursing care.
For some types of equipment such as special wheelchairs or beds, Medicare will only pay 80% of the cost. Always obtain pricing information before ordering items if there are budget concerns.
Pros and cons of home health care
Since Medicare will cover an unlimited amount of home visits for qualified individuals, the savings benefits can be significant. There are no co-pay requirements for home visits.
For most people, being at home is better for emotional health, which can spur a quicker recovery. The stress and fear felt by many people who spend their recovery time in an unfamiliar or shared room at a nursing facility can lead to other health problems.
One disadvantage of home health care is that people may start it before they are ready to leave the hospital. Some hospitals will discharge people too early, and this may lead to returning to the hospital for a longer visit or a permanent stay in a skilled facility.
People may also suffer more discomfort and pain at home without the amenities provided by a hospital. This is especially true if a patient needs frequent snacks or water and cannot call on a friend or family member in the next room to get them.
To learn more about home care and Medicare, give us a call.
Article Source: https://www.insurancenewsletters.com/
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