What you need to know about Medicare & home health care

Medicare home health care costs, payments, and how to make the right decision

According to Johnson, Fred Johnson, president and CEO of Team Select Home Care, a national home health agency, there are two primary types of home health care:

1. Skilled home health care is prescribed by a physician and includes physical therapy, occupational therapy and speech therapy, as well as care provided by a registered nurse.

2. Non-skilled home health care includes services such as bathing, cleaning and errands. This type of care is typically provided by a certified nurse assistant or home health aide.

Related reading(s): Forbes: How Much Does Home Health Care Cost?

In general, home health care includes a wide range of health and social services delivered that are given by a variety of skilled health care professionals in your home to treat illness or injury.

These services include skilled nursing care as well as physical and occupational therapy, speech-language therapy, and medical social services.

The home health staff provides and helps coordinate the care and/or therapy your doctor orders.

Along with the doctor, home health staff create a plan of care, which is a written plan for your care. This plan tells what services you will get to reach and keep your best physical, mental, and social well-being. Where possible, home health care helps you get better, regain your independence, and become as self-sufficient as possible.

Related reading(s): Medicare and Home Health Care

Medicare pays for you to get health care services in your home if you meet certain eligibility criteria and if the services are considered reasonable and necessary for the treatment of your illness or injury.

Services covered by Medicare’s home health benefit include intermittent skilled nursing care, therapy, and care provided by a home health aide. Depending on the circumstances, home health care will be covered by either Part A or Part B.

HOME HEALTH CARE NEEDS & BENEFITS

The need for home health care has grown for many reasons. Consider three following benefits of home health care:

• Medical science and technology have improved. Many treatments that could once be done only in a hospital can now be done at home.

• Home health care is usually less expensive and can often be just as effective as care in a hospital or skilled nursing facility.

Most patients and their families prefer to stay at home rather than be in a hospital or a nursing home.

WHO QUALIFIES FOR MEDICARE HOME HEALTH & DOES HOW MEDICARE PAY FOR THE SERVICES

Medicare covers your home health care if:

1. You are homebound, meaning it is extremely difficult for you to leave your home and you need help doing so.

2. You need skilled nursing services and/or skilled therapy care on an intermittent basis.

1. 1. Intermittent means you need care at least once every 60 days and at most once a day for up to three weeks. This period can be longer if you need more care, but your care needs must be predictable and finite.

   2. Medicare defines skilled care as care that must be performed by a skilled professional, or under their supervision.

   3. Skilled therapy services refer to physical, speech, and occupational therapy.

3. You have a face-to-face meeting with a doctor within the 90 days before you start home health care, or the 30 days after the first day you receive care. This can be an office visit, hospital visit, or in certain circumstances a face-to-face visit facilitated by technology (such as video conferencing).

4. Your doctor signs a home health certification confirming that you are homebound and need intermittent skilled care. The certification must also state that your doctor has approved a plan of care for you and that the face-to-face meeting requirement was met.

1. 1. Your doctor should review and certify your home health plan every 60 days. A face-to-face meeting is not required for recertification.

5. And, you receive care from a Medicare-certified home health agency (HHA).

Note: You cannot qualify for Medicare home health coverage if you only need occupational therapy. However, if you qualify for home health care on another basis, you can also get occupational therapy.

When your other home health needs end, you can continue receiving Medicare-covered occupational therapy under the home health benefit if you need it.

Medicare pays your Medicare-certified home health agency one payment for the covered services you get during a 30-day period of care. You can have more than one 30-day period of care. Payment for each 30-day period is based on your condition and care needs.

Related reading(s): Medicare Interactive: Home Health Basics; Centers for Medicare and Medicaid Services

HOW TO FIND AND COMPARE HOME HEALTH AGENCIES

Ask yourself a few questions.

• Is the home care agency licensed by the state? Most states require a license and reviews. Request a review through your state health department.

• Is the home care agency certified by Medicare to meet federal requirements for health and safety? Most home care agencies are not, but some are Medicare certified. If they are not certified by Medicare, ask why not?

• What type of screenings are performed before hiring staff?

• Ask for references. Ask for a list of doctors, hospital discharge planners, or other professionals with experience working with the home care provider.

• Ask for a list of current and former clients.

• Ask doctors, family and friends for home care recommendations.

Related reading(s): Selecting a Home Care Agency