Providing effective and safe in-home healthcare services is a must at all times. The most vulnerable group in our society, the elderly, needs more care than the average person because there are mounting health concerns. Sometimes this means that they would prefer to stay in the comfort of their home but still receive the care they need. Medicare can cover a variety of medical expenses and services. These services help them live their life comfortably and retain some of their independence. Medicare helps, but there is much to know about the services that are covered.
While it would be an ideal world for all services to fall under the blanket of medicare coverage, unfortunately, they do not but there are certainly a host of services that are valuable. These services range in providing equipment, healthcare professionals, and a range of therapy. The important part for those who might be looking for medicare coverage is to know what services they can get from their provider. Having an understanding of this is useful for a healthy life and here are the services that you can take advantage of in your home.
What is Medicare?
Briefly, to make sure everyone reading understands why medicare services for home healthcare are important, you need to know what medicare is. For those that are unaware, medicare is a federal type of health insurance for the elderly ages 65 and up. It also covers younger people with certain disabilities and those with renal kidney failure who need dialysis care. It is broken up into four sections, parts A, B, C, and D. A is for hospital insurance, B is medical insurance, C is an advantage plan, and D is prescription drug coverage. This article deals with part B, which offers services for qualifying individuals that provide them with home healthcare services.
Durable Medical Equipment
Medical equipment that is deemed durable is more advanced or expensive equipment. Things that fall under the list of durable equipment include oxygen tanks, canes and walkers, wheelchairs, hospital beds, nebulizer machines, blood sugar monitors and test strips, patient lifts, suction pumps, and many more devices for home use. This equipment is prescribed by a doctor based on the obvious needs of the patient. Medical equipment can be very expensive to pay for out of pocket, which is why it is offered under medicare coverage at a significantly reduced rate. Usually, the patient will pay 20% of the cost while medicare insurance will cover the other 80%, plus any deductibles that are under the medicare plan B coverage.
These fees are important to helping elderly and sick individuals at home live comfortably knowing that they do not have to spend the money out of pocket. Wheelchairs or walkers, oxygen tanks, or beds can be important necessities for daily life and without them, you can be susceptible to more issues, so medicare in home care needs to accommodate these concerns. Patients need the best care and these services are vital for recovery and comfortability in their own home. Plan B medicare is known as the insurance part of the medicare coverage, whereas plan A is for hospital coverage.
Skilled Nursing Care
Most recipients of medicare plan B insurance for home coverage may require a skilled nursing assistant for various reasons. These nurses are not intended to be long term care providers, as they are determined to be part-time or intermittent in their services. What this means is that the time frame of care for these skilled nurses will provide their services for less than the full 7 days out of a week, less than 8 hours in those days that they are in-home, and for a period less than 21 days. This is to provide an adequate amount of care that a patient will need. Doctors can extend this 21 day period if the patient requires it, but the doctor will create a close estimate on when the care needed will end which allows for better scheduling to compensate for the coverage.
Skilled nursing care is as the name suggests, the assistance from trained medical care professionals. These nurses are able to take care of tasks like injections, treat wounds with dressings, administer medication, change catheters, and other tasks that the patient would need assistance with. The lack of mobility, recovery from an injury, or treatment of illness puts a serious damper on the quality of life for a patient at home, which is why medicare covers this need up to a certain point. As mentioned, it is not a 24-hour live-in nurse service, which is a separate service not covered under medicare plan B, but up to 28-35 hours a week can be provided in skilled nurse coverage.
Therapy Coverage (Occupational, Speech, and Physical)
There are a lot of forms of therapy that patients need to recover from an accident or a traumatic experience relating to their condition. Therapy is not all psychological help, much of it revolves around the practice of recovering muscle functions and movement. Physical and occupational therapy help cover these in the support of patients who have fallen or had an injury that has reduced their mobility (eg. broken bones, etc.) as well as dexterity and motor-functions. Helping these patients regain that mobility and dexterity is one of the most common forms of medicare home patient recovery. As mentioned, physical recovery is not the only purpose of skilled healthcare providers in the home, speech therapy is another type of coverage.
Speech therapy helps patients regain their ability to communicate verbally. The dexterity or mobility of the hands can impair written communication, but after an accident or serious illness, the ability to speak can go as well. That is why medicare can help cover this type of therapy because a trained medical provider needs to help the patient through the recovery stages and it can be very expensive to pay for these services out of pocket. These therapists are similar to skilled nursing care in that they are only providing the amount of care within a reasonable time frame for recovery. This will be assessed based on the severity of the injuries or recovery time, but it is not a service that is long-term. Similarly, the patient must qualify for these types of therapists to help recover based on an assessment of their condition.
Social Service Coverage
In the previous section, there was a focus on more of the physical/occupational aspect of medicare coverage, with a mention of traditional forms of therapists or psychologists. These are in fact covered under medicare as a home service because of the traumatic or emotional effects of injury and illness recovery. Coping with a serious incident that results in harm to your wellbeing is difficult to handle on your own, especially when coupled with the need for potential physical rehab and being stuck at home. This is an overlooked importance in the wellbeing of patients for in-home medical care. Medicare coverage can help patients at home find the help they need to overcome the emotional and psychological difficulties while recovering.
PTSD (post-traumatic stress disorder) can occur from something as minor as a trip and fall or a vehicular accident. These might seem minor to younger folks, but for the elderly, this could mean the difference between weeks of recovery. Social services help assess the emotional damages suffered from accidents and allow for counseling as part of the recovery process. This is only for patients at home who are eligible and receiving skilled nursing care at home. The purpose of this is similar in the sense that it limits the amount of coverage for unnecessary help.
What is Not Covered By Medicare Services?
Many of the services not offered by medicare were briefly touched upon in the article so far. These services are not covered because of insurance cost reasons and because medicare home coverage is intended as short term rehabilitation measures, not extended care services, which are covered by other insurance terms or paid by the patient themselves. However, some chronic sufferers of illness or injury may be entitled to these services for extended periods, mostly for medical supplies and equipment. Some of the services not covered include; 24 hours of home care (eg. live-in nurse/care provider), home meal delivery services, homecare services like cooking, cleaning, and personal shopping, and custodial care.
Homecare services and custodial care are different because they are only exempt from medicare covered services if those are the only care you need. Custodial services fall under occupational therapy to an extent, for things like clothing and dressing a patient, but if the patient does not need durable medical equipment, medication, or other care needs, then this care is not covered. Same with homecare services if the patient is of sound mind and able body to perform these tasks on their own, otherwise this service is separate from medicare home coverage.
How Do I Know if I Am Eligible for Medicare Home Services?
Determining if you are eligible for medicare home services can be the difference between extensive medical bills, or hospital visits, and a much more manageable and comfortable home care experience. It is quite easy to determine if you are eligible or not for medicare at the home level. The prerequisites for this include: doctor advised and reviewed care/treatment plan, doctor-approved care/treatment plan with emphasis on therapy or nursing services for rehabilitation and recovery, the doctor can confirm that the patient in question is confined to the home for their condition and treatment, skilled nursing requirements are part-time/intermittent, therapy (physical, occupational, speech) are only needed for a brief period, and medicare coverage has approved of the healthcare provider offering these services and supplies for the patient.
You can see how most of these requirements are fairly easy to gauge on your own if you or someone you know needs and qualifies for medicare coverage at home. These requirements are all relatively interlinked as well, so a doctor can assess the situation quickly based on the severity of the conditions. The benefit of medicare coverage is the fact that these services are not long term and help you work through the rehabilitation phase quickly while ensuring that the recovery process is effective and long-lasting to help you return to normal. The biggest bonus is the fact that you will not be paying out of pocket. Some fees, like 20% for durable equipment, are paid by you or come out of your deductibles for insurance, but you do not pay for any of the services out of pocket, which can save you a lot of trouble and give you peace of mind about other stressors during this period of recovery.
Who Offers Medicare Coverage?
There is a wide range of home health agencies (HHA) that can help you receive the care you need. The list depends on what coverage you need, as well as your state. These factors will determine the coverage options in your area so you should consult with a nurse practitioner, physician, or doctor of your choice before choosing one. Your doctor will be able to assist in finding an HHA that is approved under medicare guidelines and requirements. There are a lot of choices so it is important to understand which services can help you when it comes to deductibles or premiums for your health insurance.
Pre-claim reviews are a common practice to ensure that you are under the requirements for the home health agency to provide these services. Finding the right provider is important to keeping you safe and healthy, and giving you the best possible care to recover quickly.
Knowing what services are offered by medicare can help you determine if you qualify for home healthcare coverage through medicare, and help you get better. It is also important to know what medicare is and how to find coverage, as well as the steps to get the coverage you need. All of this information should serve you well in determining your situation and help save money on hospital visits if you can receive home care through medicare.