What Home Health Care is Covered by Medicare

Home health care can be a vital service for Medicare recipients with serious illnesses or disabilities, but its quality varies widely. Most home health services are typically provided through Community Home Health Agencies (CHHAs), approved by Medicare. Before getting home health coverage through one of these agencies, however, a doctor must complete paperwork certifying their need and send paperwork directly to them so they can send a nurse who will assess what services will be covered and evaluate this need before sending back paperwork to CHHA.

Medicare Home Health Benefit provides part-time skilled nursing or therapy services ordered by your physician that are medically necessary. These may include physical therapy, occupational therapy and speech-language pathology services as well as medical supplies and durable medical equipment (DME) such as wheelchairs or walkers – typically Medicare covers 80% of its Medicare-approved amount while you pay 20% coinsurance once meeting your Part B deductible.

However, Medicare does not cover non-skilled personal care services like bathing and dressing assistance or help preparing meals in the home, nor long-term home care provided by care facilities. Home health agencies must inform you in advance about which services or supplies Medicare will not cover by verbally notifying them as well as providing written notice called an ABN notice – this process is known as Advance Beneficiary Notice or ABN notices.

Many seniors who receive home health care are living with chronic illnesses such as diabetes or Alzheimer’s, while others may be recovering from surgery or illness. Home health care aims to expedite these processes so people can return quickly to normal daily activities.

To qualify for home health care services, it is necessary to fulfill certain criteria:

An accredited doctor or nurse practitioner must visit you at home to certify your need for home health care. In particular, difficulty leaving home without assistance such as cane or wheelchair use or special transportation must exist or someone to accompany the individual on any outings must also exist.

Home health care typically lasts 28-35 hours per week; however, if your condition requires continuous attention from home health services, a physician can extend this limit accordingly.

If you are enrolled in a Medicare Advantage plan with a private insurer, check the terms of your policy to see if home health care coverage is included. Recently, many Medicare Advantage plans have reduced their supplemental home health benefits as part of changes to how Medicare reimburses providers for such services.

The Center for Medicare Advocacy has received calls from beneficiaries across the country who claim they have been told their home health care coverage has been denied due to not fulfilling its criteria for improving health. Judith Stein, executive director of the Center for Medicare Advocacy notes that recent changes in payments to home health providers may play a part in this decision, although a 2013 settlement recognized home health coverage must only be approved when needed to keep health intact.

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