Essentially, home health services are something to rely upon when hospital and skilled nursing facility care are found impractical by individuals recuperating from an illness or injury. Such services are less expensive yet would not compromise quality with the patient’s home comfort. Medicare covers this home health care under Part A (Hospital Insurance) and/or Part B (Medical Insurance), whereby it would be available to the criterion individuals-feeding number one, requiring part-time or intermittent skilled services, and requiring to be considered “homebound.”
The condition that defines homebound shall apply if the person finds it hard to leave home without assistance using a cane, wheelchair, walker, or another person’s help. In a few conditions, leaving home may not be a really good idea for a certain individual and would take a great deal of effort before it can be done. The recognition of that is Medicare’s coverage for home health services on a great number of services that are applicable to meet such needs.
Covered are the home health services that offer some kind of skilled nursing care on an intermittent or part-time basis. This care may involve wound care for surgical or pressure wounds, delivery of intravenous or nutrition therapy, injections, or monitoring of health conditions. Educate patients and caregivers on the management of their appropriate health conditions. Home health services comprise physical therapy, occupational therapy, and speech-language pathology rehabilitation to improve mobility, communication skills, and recovery. Those who may require emotional or social support will find medical social services useful.
Assistance in walking, bathing, grooming, having to feed, or changing bed linens is generally provided by the home health aides. The only part of the services that they pay for will, however, be the part that goes with the skilled nursing care and/or therapy services therein. Benefits covered by home health care include osteoporosis injectables for women, durable medical equipment, medical supplies for home use, and disposable negative pressure wound therapy devices.
Home health care begins with a face-to-face visit from a doctor or other qualified health care provider, such as a nurse practitioner, for a legitimate assessment of need certification. Care must be provided by a Medicare-certified home health agency. Providers must give clients a list of local home health agencies and review their financial interest in the recommended agencies. Most times, “part-time or intermittent” is interpreted as receiving less than eight combined skilled nursing and aide services daily and is limited to 28 hours in a week. More often, care is possible in some cases, but only temporarily and with approval by a provider, for a maximum of 35 hours per week.
The above spelled out-disallows Medicare from providing coverage for any of its medical services such as providing a client with home-based care for 24 hours, meal delivery, or homemaking services that are unrelated to the care plan (shopping or cleaning). In fact, custodial or personal daily living activities, for example, dressing or using the bathroom, do not form part of services under this plan unless combined with skilled nursing care or therapy services—the custodial activity. Any person who requires further skilled care beyond part-time hours will not qualify to receive this home health benefit. Brief, infrequent absences away from home for medical treatment or non-medical reasons such as going to church count as exceptions. No one individual will be considered unqualified to receive home health care because he participates in adult day care.
Costs for home health services under Original Medicare include $0 for covered services, with a 20% coinsurance payment for medical equipment after meeting the Part B deductible. Before services begin, the home health agency should clearly explain which costs are covered by Medicare. If Medicare will not cover certain items or services, the agency must inform you through an “Advance Beneficiary Notice” (ABN). Individuals enrolled in Medicare Advantage Plans (Part C) or other health plans should verify their home health benefits with their plan providers.
The Medicare demonstration program may include residents from Florida, Illinois, Ohio, North Carolina, and Texas, which is designed for home health agencies to pre-claim coverage requests to Medicare. It will help determine early whether one is available for coverage or not. However, it should be noted that this step just adds a level of inconvenience to patients. Access to home health services remains unchanged, and benefits are not different. For further inquiries, people can call Medicare at 1-800-MEDICARE or TTY 1-877-486-2048.
After a referral for home health services, the agency will schedule an initial visit to assess the individual’s needs and develop a care plan in consultation with the doctor or provider. Home health staff ensure regular visits as outlined in the care plan and provide updates on progress. This coordinated effort between the individual, their doctor, and the home health agency ensures a seamless and effective care experience.
