Home Health Care Services Covered under Medicare A - dummies

Home Health Care Services Covered under Medicare A

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Medicare Part A is usually associated with care within the hospital, of course. But it also covers certain specialized services outside the hospital, most of which focus on nursing. These services provide some of the same types of care that you may get in a skilled nursing facility but bring them to you in your own home. They include

  • Skilled nursing care provided on a part-time basis (no more than 8 hours a day over a period of 21 days or less) and including services such as injections, feeding through a tube, and changing catheters and wound dressings.

  • Physical, speech, and occupational therapy from professional therapists to help you walk again, overcome problems in talking, or regain the ability to perform everyday tasks, such as feeding and dressing yourself — whichever your medical condition requires.

  • Help from home health aides in personal activities such as going to the bathroom, bathing, dressing, or preparing a light meal if these are necessary in relation to your illness or injury. (But if this personal care is the only kind of care you need, you don’t qualify for home health coverage.)

  • Medical supplies such as catheters and wound dressings.

  • Medical social services such as counseling for social or emotional concerns related to your illness or injury and help finding community resources if you need it.

Medicare covers all these services in full by paying a home health agency a single payment to provide them for 60 days at a time. Home health care is a valuable benefit, but the rules for qualifying are pretty strict. To get Medicare coverage, you must meet all these conditions:

  • You must be homebound — that is, unable to leave home without considerable effort, unaided, or at all.

  • A doctor must certify that you need one or more of the professional services in the preceding list (skilled nursing, physical or occupational therapy, or speech pathology).

  • You must be under a plan of care established and regularly reviewed by a doctor.

  • The home health agency caring for you must be approved by Medicare.

If you qualify, the agency must provide all the services specified in the doctor’s plan of care for you. But if you need (or ask for) an item or service that Medicare doesn’t cover, the agency must tell you so in advance and explain what it would cost you.

If you need medical equipment, such as a wheelchair or a walker, while receiving home health care, you may get it through the agency, but you pay the normal 20-percent co-pay unless you have Medigap insurance that covers that cost.