Most of us feel relaxed thinking we have coverage for any unforeseen emergency that may require hospitalization and involves huge expenses. But, have you thought of those small expenses that can turn into a mountain over a period of time?
I am talking about the cost of home care services!
There are several disorders that require long-term care by a nurse or a home caregiver. If you stay in New York or nearby cities, read further to find whether the services by your preferred home care agency in New York would be covered by Medicare.
Does Medicare Cover Home Health Care?
Health services received at home include a range of treatments delivered in your home for the management of illness or injury. Some of the services covered by Medicare’s home health benefit are physical therapy and intermittent skilled nursing care.
Depending on the circumstances, the costs of these services are covered by Part A or Part B of Medicare.
Medicare Part A covers the costs incurred during hospitalization only. It would cover the expenses of bed charges, doctor visits, surgery performed, or any other therapy received during the patient's hospital stay.
Once the patient is discharged from hospital, he may still need home care, especially if the condition has caused considerable morbidity or restriction of movements.Home care services are also needed when the patient requires to continue receiving therapies for complete recovery.
Medicare Part B covers some of the costs patients have to incur for the healthcare services received at home following discharge from the hospital. Part B also covers home health care when there is no prior hospital stay. Part B-covered health care at home does not require coinsurance or deductibles.
Medicare Part B covers home health care costs when:
The patient is homebound, which means he suffers from a disorder or an injury that makes it extremely difficult for him to leave the home. In such cases, the healthcare services by a registered nurse may be provided at home.
Some of these conditions include accidents, fractures, immobility due to stroke, or paralysis and post-surgical recovery. In these cases, the services are offered for several days or months on a regular basis. You can check the reviews of your preferred home care
agency to find the quality of services offered by each so that you can choose the best one.
Other than the regular healthcare, skilled therapy and nursing services required on an intermittent basis are also covered by Medicare Part B.
• Intermittent care refers to the healthcare services provided at least once in every 60 days and not more than once a day for a period of up 3 three weeks.
• The period may be longer, in some cases, particularlywhen the medical condition of the patient necessitates the services to be continued. However, in this case, the duration of care needs to be finite and predictable.
Following conditions have to be fulfilled to be eligible for the coverage of intermittent home care services by Medicare B.
1. The skilled care and skilled therapy received should conform to the conditions specified by Medicare as follows.
• Skilled care is defined by Medicare as the services that are performed by skilled professionals or under their supervision.
• Skilled therapy services include physical, occupational, and speech therapy.
2. The patient must have a face-to-face consultation or meeting with the physician within 90 days before beginning the home health care or 30 days after the 1st day of receiving care.
The meeting should take place in the clinic or hospital. In certain circumstances, a face-to-face consultation facilitated by technology like video conferencing is also covered by Medicare.
3. The home health certification must be signed by the physician confirming the patient is homebound and needs intermittent skilled care. The certification should also state implicitly that the doctor has approved the plan of home care and that the requirement for the face-to-face meeting has been met with.
4. The physician must review and certify the home healthcare plan every 60 days. The face-to-face consultation is not needed for recertification.
5. Your preferred home care agency in New work
or the region you are located in from which you receive the services must be a Medicare-certified homehealth agency (HHA).
You would be eligible for Medicare coverage only when all of these criteria have been fulfilled. However, it should be noted that Medicare does not cover home health when the patient needs only occupational therapy.
Patients may be eligible for Medicare coverage for occupational therapy when it is included in the overall treatment plan for the management of a particular disease or injury. In this case, you would continue receiving the Medicarecoverage for occupational therapy even after your other healthcare needs have ended and the doctor has recommended continuing the therapy.
If you meet all these requirements, Medicare would cover skilled home care provided by your preferred home care in Brooklyn, NY
, supposing you are located in this region.
Other than these Medical social services and personal hands-on care are also covered by Medicare part B. These services can be received on a part-time or intermittent basis.
Now, that we have learned when home health care services are covered by Medicare, let us have a look at the services that would not be covered by the plans.
Which home care services are not covered by Medicare?
Health care services that do not fulfill the criteria mentioned above are not covered by Medicare Part A and B. Here are some other services that are specifically excluded from the Medicare coverage:
• 24-hour-a-day care serviced at home
• Housekeeping services
• Meals delivered to the patient’s home
• Personal and custodial care like bathing, using the bathroom and dressing when this is the only care needed by the patient
It would be wrong to assume that healthcare expenses have more to do only with hospitalization. With rising healthcare costs, it has become imperative to be aware of which expenses related to the treatment of diseases would be covered by Medicare. People staying in or around Brooklyn are advised to ensure they have their Medicare plans in place so that the services they might have to seek from their preferred home care agency in Brooklyn, NY
, would be covered. This would help them avoid huge liabilities on their financial position.