By David Sayen
Gazette Contributor
Medicare
covers a variety of heath care services that you can receive in the
comfort and privacy of your home. These include intermittent skilled
nursing care, physical
therapy, speech-language pathology services, and occupational therapy.
Such
services used to be available only at a hospital or doctor’s office.
But they’re just as effective, more convenient, and usually less
expensive when you get them
in your home.
To be eligible for home health benefits, you must be
under a doctor’s care and receive your services under a
plan of care established and reviewed regularly by a physician. He or
she also needs to certify that you need one or more home health
services.
In addition, you must be homebound and have a doctor’s certification to that effect. (Being homebound means leaving
your home isn’t recommended
because of your condition, or your condition keeps you from leaving
without using a wheelchair or walker, or getting help from another
person.)
Also, you must get your services from a home health agency that’s Medicare-approved.
If
you meet these criteria, Medicare pays 100 percent for covered home
health services for as long as you’re eligible and your doctor certifies
that you need
them.
For
durable medical equipment (like a walker, wheelchair, or oxygen
equipment), you pay 20 percent of the Medicare-approved amount, after
you pay the Part B deductible
($147 in 2013).
Skilled
nursing services are covered when they’re given on a part-time or
intermittent basis. In order for Medicare to cover such care, it must be
necessary
and ordered by your doctor for your specific condition. Medicare does not cover full-time nursing care.
Skilled
nursing services are given by either a registered nurse or a licensed
practical nurse under an RN’s supervision. Nurses provide direct care
and teach you and your
caregivers about your care. Examples of skilled nursing care include:
giving IV drugs, shots, or tube feedings; changing dressings; and
teaching about prescription drugs or diabetes care.
Any service that could be done safely by a non-medical person (or by yourself) without the supervision of a nurse,
isn’t skilled nursing care.
Physical
therapy, occupational therapy, and speech-language pathology services
have to be specific, safe, and effective treatments for your condition.
Before
your home health care begins, the home health agency should tell you
how much of your bill Medicare will pay. The agency should also tell you
if any
items or services they give you aren’t covered by Medicare, and how
much you’ll have to pay for them.
This
should be explained by both talking with you and in writing. The agency
should give you a notice called the Home Health Advance Beneficiary
Notice before
giving you services and supplies that Medicare doesn’t cover.
What isn’t covered? Some examples:
· Meals delivered to your home;
· Homemaker services like shopping, cleaning, and laundry (when this is the only care you need, and when these services aren’t related to your plan of care);
· Personal care given by home health aides like bathing, dressing, and using the bathroom (when this is the only care you need).
If your doctor decides you need home health care, you can choose from among the Medicare-certified agencies in your area. (However, Medicare Advantage plans may require that you get home health services only from agencies they contract with.)
One good way to look for a home health agency is by using Medicare’s “Home Health Compare” web tool, at
www.medicare.gov/HHCompare. This tool lets you
compare home health agencies by the types of services they offer and the quality of care they provide.
For more details on Medicare’s home health benefit, please read our booklet, “Medicare and Home Health Care.” It’s online at
http://www.medicare.gov/
David
Sayen is Medicare’s regional administrator for Arizona, California,
Nevada, Hawaii, and the Pacific Territories. You can always get answers
to your Medicare
questions by calling 1-800-MEDICARE (1-800-633-4227).
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