by Jon Costa
The Medicare Minute for August, 2014 provided by the Medicare Rights Center and the State Health Insurance Assistance Program, is entitled “Medicare Coverage of Home Health Care.”
Home health care is care you get at home to treat an illness or injury. If you or a loved one needs help at home, it is important to understand how Medicare covers home health care.
Point 1: Know how to qualify for Medicare-covered home health care.
You must meet four requirements to qualify for Medicare coverage of home health care, whether you have Original Medicare or a Medicare Advantage plan:
You must be homebound, meaning it is extremely difficult for you to leave your home. For example, you need a walker or help from another person to leave your home.
You must need skilled care, which is care provided by either a nurse or a skilled therapist, such as a physical therapist, speech therapist, or occupational therapist. You must also need skilled care intermittently, meaning you need care no more than once per day.
Your doctor must certify that you need home health care. To do this, your doctor must sign a home health certification saying that you are homebound, need intermittent skilled care, and have had a face-to-face visit with a health care provider.
You must receive care from a Medicare-certified home health agency. If you have Original Medicare, find a Medicare-certified agency by calling 1-800-Medicare or visiting www. Medicare.gov. If you have a Medicare Advantage plan, contact your plan to find agencies that are in your plan’s network.
Keep in mind that help with personal care alone – such as bathing, dressing, cooking, and cleaning – does not qualify as skilled care. A home health aide may help you with some personal care only if you are also receiving skilled nursing care or therapy services. Medicaid or long term care insurance may help cover the care you need if you don’t qualify for Medicare-covered home health care.
Point 2: Understand Original Medicare costs and coverage of home health care.
If you have Original Medicare and you meet the requirements, it will cover approved home health care. Depending on your need, this includes skilled nursing care, therapy, home health aide services, medical social services, and certain medical supplies provided by the home health agency.
Generally, Medicare covers the full cost of approved home health care services. Medicare will pay for skilled care and home health aide services every day, but for no more than 28 hours per week (no more than eight hours on any given day). In rare cases, this can be extended to 35 hours per week. Your home health care should continue for as long as you continue to meet the criteria.
Point 3: Understand Medicare Advantage costs and coverage of home health care.
Medicare Advantage plans must follow Original Medicare’s coverage rules for providing you with home health care, but can impose different costs and restrictions. You usually have to go to an in-network home health agency, and you may need prior approval from your plan before receiving home health services. Some plans may charge a copayment for home health services, even though Original Medicare does not. Contact your Medicare Advantage plan using the number on your plan card if you are unsure how it covers your home health care.
If you have any questions, please contact the Alabama SHIP helpline 800-AGELINE (800-243-5463).
Jon Costa is the Program Specialist at The Council on Aging of Etowah County.