Have you read the fine print of your Medicare coverage and wondered how long it would take to get home health care services taken care of? As an older adult or family, you know that finding proper medical care is essential – especially if severe conditions require immediate attention. Therefore, you want to understand what’s covered to make the most informed decisions about health costs and accessibility for yourself or those in your loved ones’ circle who are elderly.
Home health care comes sharply into focus – so let’s discuss how long will Medicare pay for home health care when looking into this option.
What is Medicare Coverage for Home Health Care
Medicare coverage for home health care provides seniors the care they need at home. It covers a wide range of services, including nursing visits, physical therapy, medical social services, and medical supplies. In addition, home health services also cover any required medical equipment, such as walkers and wheelchairs. Home health care is essential because it enables seniors to remain independent while receiving the critical medical care they need.
Medicare coverage is available to those under the care of a doctor or other eligible practitioner who meets specific criteria, such as being physically disabled. In addition, with its comprehensive coverage options and the freedom of staying in their environment, Medicare makes healthcare more accessible to individuals over 65.
What are home healthcare services covered by Medicare?
Home health care is available for those who need skilled nursing or therapy on an intermittent basis to treat an illness or injury or those who require medical social services to help them cope with their condition. Examples of these services include:
- Routine home care
- Home health aide services
- Medical social services
- Physical therapy
- Speech-language therapy
- Occupational therapy
- Skilled nursing services
How Long Does Medicare Pay for Home Health Care
Medicare will provide part-time or “intermittent” home health care for three weeks or less, provided the services needed are no more than seven days per week and eight hours per day. The patient’s doctor must recertify their plan of care every 60 days if it is necessary to receive additional treatment.
The frequency and duration of the care a senior receives are determined by Medicare standards. If the needs exceed what is offered as intermittent care, Medicare no longer pays for the service. Instead, they view home health care as a way to prevent or delay being placed in an assisted living community or skilled nursing facility.
What factors can impact the length of Medicare coverage for home healthcare?
Many factors can influence the length of care you receive when it comes to Medicare coverage for home healthcare. These can range from the following:
- Unforeseen illnesses or injuries
- Severe or chronic conditions
- Cost of care and services required
- Changes in patient’s condition over time
- Availability of any alternative treatments to home healthcare
- Patient’s overall health, medical history, and state of residence
Requirements for Medicare Coverage for Home Health Care
To be eligible for home health benefits from Medicare, you must meet the following criteria:
- Be homebound. It means that it takes a great deal of effort and assistance from someone else or a device like a walker or a wheelchair for you to leave your house.
- Have certification from a primary care physician or another medical professional (like a nurse practitioner) that shows your need for intermittent occupational therapy, physical therapy, skilled nursing care, or speech-language therapy. Additionally, this certification must be based on a face-to-face encounter with the doctor within 90 days before or 30 days after starting your home health care services.
- Be under a plan of care established and reviewed regularly by a doctor. The plan should include all necessary services and how often they are needed, provide information on the provider, and list required supplies and any results your doctor anticipates. The doctor and home health team must review and recertify the plan at least once every 60 days.
If you are on Medicare, you can use the search and comparison tool on Medicare.gov to easily find certified home health agencies in your area that accept Medicare coverage.
If you are using a private Medicare Advantage plan instead of the original Medicare, then contact that plan’s representative for details about what agency needs to be used and any coverage requirements. Remember to get verbal and written confirmation from the agency before services begin regarding what is covered by Medicare and what services will require a separate payment from you.
Understanding the Cost of Home Health Care
Home health care services can be a costly expense – and with the cost of living continuing to rise, understanding how much home health care services cost is essential. On average, the cost of in-home health care per hour ranges from $18 to $25, depending on the location and services provided.
However, suppose you are eligible for Medicare coverage. In that case, you can expect to pay significantly less out-of-pocket, as many Medicare plans cover some or all of the costs associated with certain home healthcare services. This can significantly reduce the overall cost of home healthcare services.
Additionally, it’s essential to understand that there may be other out-of-pocket expenses, such as an initial home evaluation or mileage costs for travel between appointments, that are not always covered by insurance plans. All told, when considering these additional costs and overall coverage from Medicare and other insurance providers, it’s possible to have a better idea of the actual cost of home health care.
Home health care can be a great, cost-effective option for those who qualify for Medicare coverage. Understanding how long a home healthcare service may be covered is important in deciding what type of health care will work best for you. It’s always best to talk with a professional like those at Care & Help Home Care for more information about your specific circumstances and questions about other available healthcare coverage forms. Home health care is a great resource; understanding your eligibility is key to maximizing it.