Medicare Coverage | Home health agencies

Home Health Agencies And Medicare

If you ever get sick and need health care help at home, that's when home health agencies help. Perhaps you have a surgery and need help after an operation. Or maybe you need a temporary nurse instead of going into a nursing home. Those are just a couple situations when home health agencies are used.

What Is A Health Agency?

Depending on which agency you use, all the services can be different. They can offer things like:

• Skilled nursing care
• Physical therapy
• Home health aide services
• Plus, they can also help you and your family know how to care for yourself

How Do You Know If You Need A Health Agency?

If you are right for home health care, your doctor or hospital personnel will let you know. They will also help give you information about who to call. Always talk to your doctor for treatments for any health condition.

Is It Covered Under Medicare?

That's a good question. And that depends on many factors. These are the services that Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance) covers:

• Part-time or intermittent skilled nursing care
• Part-time or intermittent home health aide care
• Physical therapy
• Occupational therapy
• Speech-language pathology services
• Medical social services

What Medicare doesn't cover:

• 24-hour-a-day care at home
• Meals delivered to your home
• Custodial or personal care (help bathing, dressing, etc.) when this is the only care you need
• Homemaker services

Who is eligible for coverage?

Medicare occasionally pays for at-home-care through a Medicare-certified home health agency. In order to quality, your doctor must certify that all of the following are true:

• You are under a doctor's care and also a Medicare beneficiary
• You are homebound and a doctor certifies that you are
• Your doctor must order these services for you and also must certify that you need at least one of these
• Skilled nursing care (besides drawing blood)
• Physical, occupational, or speech therapy, according to Medicare restrictions and guidelines

Because your doctor could order different services, be sure to ask your whether you would need to pay for any of the services he or she wants you to have.

Alternatives to home health agencies

• Some federal and state-subsidized senior housing programs may offer assistance for older people with low to moderate incomes, who need help with tasks, like shopping and laundry. Call your Medicaid agency for more information.
• Sometimes "assisted living" arrangements offer services to people who live in an assisted living facility. This can include cooking, laundry, or reminders to take medications. As a note, assisted living facilities can cost thousands of dollars per month, and usually are not covered by Medicare.
• There are board and care homes for people who cannot live independently, but don't need nursing home services. These homes are like group living situations and the staff usually provides help with certain daily living activities, such as eating, bathing, walking, and toileting. Medicare does not cover this but private long-term care insurance and medical assistance may help cover this