Medicare alone will not meet your long-term care (LTC) needs. While Medicare covers some home health, skilled nursing and hospice care, it generally does not cover custodial care, such as cleaning or cooking, at home or in a nursing home. Medicare will help pay for your home care if:
• Your doctor certifies that you are homebound, meaning it takes a considerable and taxing effort to leave your home; and
• You need skilled physical, speech or occupational therapy services, or skilled nursing on an intermittent (less than seven days a week) or part-time (less than eight hours a day) basis. If you only require skilled nursing, you must either need it fewer than seven days a week (even as little as once every 60 to 90 days) or daily (seven days a week) for a short period of time (usually two to three weeks); and
• Your doctor certifies your need for home care, and
• You receive your care from a Medicare-certified home health agency (HHA).
If you qualify for the home health benefit, Medicare covers the following types of care:
1.) Skilled nursing services. Medicare pays in full for skilled nursing, which includes services and care that can only be performed safely and effectively by a licensed nurse. Administration of medications, tube feedings, catheter changes, observation and assessment of a patient’s condition, management and evaluation of a patient’s care plan, and wound care are examples of skilled nursing. Any service that could be safely performed by a nonmedical person (or one’s self) without the direct supervision of a licensed nurse is not covered.
2.) Skilled therapy services. Medicare pays in full for physical, speech and occupational therapy. Physical therapy includes exercises to regain movement and strength to a body area and training on how to use special equipment. Speech-language pathology services include exercises to regain and strengthen speech and language skills. Occupational therapy helps you become able to do usual daily activities by yourself, such as eating and putting on clothes. Medicare will pay for therapy services to maintain your condition and prevent you from getting worse; you do not need to have the potential to improve.
3.) Home health aide services. Medicare pays in full for a home health aide if you require skilled services. A home health aide provides personal care services including help with bathing, using the toilet, and dressing. If you ONLY require personal care, you do NOT qualify for the Medicare home care benefit.
4.) Medical social services. Medicare pays in full for services to help you with social and emotional concerns you have related to your illness. This might include counseling or help finding resources in your community.
5.) Medical supplies. Medicare pays in full for medical supplies provided by the Medicare-certified home health agency, such as wound dressings and catheters needed for your care.
6.) Evaluation services. Medicare pays for evaluation services if performed by a skilled nurse or therapist.
7.) Durable medical equipment. Medicare pays 80% of its approved amount for certain pieces of medical equipment, such as a wheelchair or walker.
The Medicare home health benefit covers a wide range of skilled nursing services as long as you need them fewer than seven days a week, or daily for a finite and predictable period of time (usually no more than 21 days in a row). Skilled nursing care includes services that can only be performed safely and correctly by a licensed nurse (either a registered nurse or a licensed practical nurse) and is under the general direction of a doctor. For example: intravenous injections; tube feeding; oxygen to help you breathe; changing sterile dressings on a wound; training you to perform required tasks, maintenance and evaluation. Any service that could be safely performed by a nonmedical person (or one’s self) without the direct supervision of a licensed nurse is not covered. Regional Home Health Intermediaries (RHHIs) handle home health and hospice claims. You can call your intermediary for claim issues, and questions about coverage, complaints or denials. For additional info and a complete glossary of medical terms refer to http://www.medicareinteractive.org/page2.php?topic=counselor&page=glossary. [Source: Medicare Rights Center www.medicareinteractive.org May 08 ++]