If you are over 65 or older, you qualify for Medicare. Many people incorrectly think that Medicare will pay for all of their health care needs when they are older, but this is not necessarily true. When it comes to home health care, Medicare will only pay for skilled-type services. These are services that can only be provided by a skilled, licensed clinician like a nurse or a therapist.
If you have been hospitalized, and still have the potential to improve as you are discharged home, your doctor may prescribe a home health care assessment. Many hospitals have their own home care company but you can choose any company as your home care provider. Within a day of returning home, a nurse or physical therapist will come to your home to complete an assessment of your needs. This information is submitted to your doctor and he/she will approve services appropriate for your needs. For example, if you need nursing care, a nurse may visit you two or three times per week. Your home health care nurse may also educate you or a family member about how you can begin to perform your own nursing care (as appropriate). Every Medicare approval period, or “episode”, lasts about 30-60 days, as long as you are working hard and making progress. You may even be approved for an additional days if needed. If you get better sooner, or no longer need this specialized assistance, your services will be discontinued. Aside from hospitalization, other common reasons one begins receiving Medicare home health care is if they have a new diagnosis, or if their condition has suddenly declined.
Other services available during your episode(s), depending on your health care needs, may be physical therapy visits to help you regain your strength and mobility, or a social worker to help you access community resources, or an occupational therapist to ensure you can perform all of your own self-care safely. You may even qualify for a few Home Health Aide visits. Your Home Health Aide can help you bathe until you can do so on your own or with help from a trained family member. None of your clinicians can help you with ongoing safety and supervision, or to do your laundry (for example) if you cannot go up and down steps when you return home; Medicare pays for skilled services only.
Medicare will pay 100% for the services described above if you qualify. If you need a walker to move around safely Medicare may only pay 80%, so you’ll have to pay the remaining 20% out-of-pocket or through a supplemental insurance if you have one.
Our, ‘Do I Qualify for Medicare Home Health Care?’ checklist is a helpful tool for understanding if Medicare home health care is an option for you:
Do I qualify for Medicare Home Health Care?
Medicare home health care services are for clients for whom it is a taxing effort to leave home, who have had a recent decline in condition, and need skilled nursing or therapies to get better. It is NOT long-term care. Our Medicare services include skilled nursing, physical, occupational and speech therapies, social worker services and Home Health Aides (for baths only).
What are the Warning Signs you or your loved one needs help?
Problems Taking Medication Correctly
Decline in health
New diagnosis (such as CHF, COPD, or diabetes)
Won’t leave home
Concerns about safety
Planned hospitalization or surgery (knee or hip replacement, bypass, etc.)
To qualify for Medicare home health care, you:
Must be Medicare-eligible (65+, disabled or kidney disease)
Must need skilled nursing and/or therapy
Must have potential to improve as a result of care
Must be under a physician’s care
Must be homebound, which means:
Unable to leave home w/o assistance
Away from home only for short intervals
Any absence requires a taxing effort
Patient can attend religious services, go to healthcare appointments and grooming appointments
If you checked any Warning Sign(s), and all of the qualifiers, please call Cooperative Home Care to get started!