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You Need In-Home Health Care. Does Medicare Cover That?


The U.S. Department of Health & Human Services estimates that if you are around the age of 65, you have a nearly 70% probability of later in life needing some kind of long-term care as you recuperate at home. That can entail assistance with activities like dressing, meal preparation, and bathing.

The good news is that Medicare Advantage (Part C) and Original Medicare, both Part A, and Part B, may be able to assist pay for at least some of that home health care. What you need to know is as follows.

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Which types of home health care do Medicare cover?

Depending on why home health care is required, Medicare Part A or Part B may cover the cost of that treatment.

For instance, she explains, if you require home health care as a result of hospitalization, Medicare Part A (hospital insurance) would pay for it. Part B might be applicable if you require home health care owing to a medical condition, such as diabetes (medical insurance).

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Medicare will pay for a range of home healthcare services and supplies, including:

Physical therapy can be used to treat illnesses or injuries that have made it difficult for you to go about your daily activities.

With the aid of occupational therapy, you can carry out daily tasks like getting dressed or taking a shower.

Speech-language therapy can help you improve your ability to swallow as well as your ability to speak and communicate.

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wheelchairs, walkers, and nebulizers are examples of durable medical equipment.

medical equipment for home use

Medicare also pays for certain skilled nursing or medical assistant services, such as:

Part-time skilled nursing care (if it is provided for less than eight hours per day for less than seven days in a row)

Care from a part-time home health aide (However, only if you are receiving additional skilled nursing or therapy services at the same time.)

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If you require these services, your doctor will ordinarily place the order. Then, a home healthcare company that is approved by Medicare will assist in coordinating your treatment.

These services are also covered by Medicare Advantage, a private insurance company-run plan that has been authorized by Medicare. According to Miller, if a benefit is provided by Original Medicare, it must also be provided by Medicare Advantage.

Which home health services won’t Medicare pay for?

Not all types of home health care are covered by Medicare. For instance, it won’t cover:

24-hour care provided in your home

delivery of meals to your house

If this is the only form of care you require, housekeeping services like grocery shopping, cleaning, and laundry (such as getting dressed or using the restroom) are provided.

Who may be eligible for home health aides under Medicare?

You must fulfill several requirements to be eligible for Medicare home health care coverage. You must, for instance:

Be treated by a medical professional who routinely evaluates your treatment strategy.

Be homebound, which means you have problems leaving your house without a walker or wheelchair and your doctor has confirmed that you are homebound.

Have a doctor certify that you require one or more of the following medical services:

competent nursing care on demand (other than drawing blood)

Speech-language pathology, physical therapy, or ongoing occupational services

To be considered homebound, you do not need to live there constantly. You can still periodically leave the house to go to the doctor or for a quick, non-medical function like church.

How much do home health services cost?

Generally speaking, home health care coverage under Medicare is free. However, after meeting your deductible, you typically pay 20% of the Medicare-approved amount if you require durable medical equipment (DME). You’ll need a doctor who accepts Medicare to order this for you before Medicare will authorize the coverage.

You can learn more about the services that Medicare covers and to what extent from your home health agency, which will assist you throughout this period. The agency will notify you via an Advance Beneficiary Notice if it provides any “additional” materials or services for you that are not covered by your insurance (ABN). The products that Medicare won’t cover are listed on an ABN.

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Getting home health services in certain states

You might be qualified for a Medicare demonstration program if you reside in Massachusetts, Michigan, Florida, Illinois, or Texas. By this program, you (or your home health care provider) can ask for a pre-claim evaluation to determine whether Medicare is likely to pay for your home health services in advance.

When your doctor recommends home health care, if you live in one of these states, you might wish to ask for a pre-claim review. This will enable you to determine if you will be responsible for making any payments as soon as feasible.

Are you prepared to begin? Find a plan that covers your doctor and prescription drugs and meets your budget right away.

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