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Home Health Care: Keeping Medicare Beneficiaries at Home
What Is Home Health Care?
The term "home health care" is used to describe a wide range of services provided to seniors in their home. They include medical and non-medical services. The purpose of the services is to keep seniors out of the hospital or nursing home, and as independent for as long as possible. The services provided can be as simple as help with daily activities such as cooking, cleaning, and bathing or as complicated as medical care that requires a licensed and skilled health care provider. Most people who require these services are recovering from an illness or injury, or are living with a long-term medical condition.
Is There an Advantage to Receiving Care in My Own Home?
The good news is that today many types of medical treatment can be done in your own home. Home treatment is less expensive, more convenient, and just as successful as the care you get in the hospital or nursing home. In addition, it is better for you if can stay in your own home.
- According to a 2006 study by AARP, ninety percent of older Americans want to stay in their own home and remain as independent for as long as possible.
- According to the American Association of Homes and Services for the Aging in Washington, D.C., older Americans report they feel better and younger when they are able to receive assistance and medical care in their own home.
- A 2008 article published by the Agency for Healthcare Research and Quality showed assisted living care in the home reduced the use of more expensive hospital services.
What Kind of Services Can I Get in My Home?
Today there are a full range of services that can be provided in your home. Some of the most common services used are:
- Help with personal care and mobility
- Bill paying services
- Meals On Wheels
- Telephone support
- Case management
- Medical care in the home by a licensed health care providers
Who Provides the Services?
In most communities there are a number of licensed home health care agencies that can provide any level of home care needed. Many people use a combination of family, friends, and professional services for their home care. In most cases your doctor will remain very involved with the care you receive from the agency. Hospitals are required to give you a list of local home care agencies when you are discharged. Your doctor can also provide recommendations.
How Much Does Home Care Cost?
Home care costs can vary depending on where you live, the type of care you need, and how often you need care.
Is Home Care Covered by Medicare?
Medicare will cover some of the costs of home care. For example, if you only need help with daily activities (cooking, bathing, etc.), Medicare will not cover it. However, Medicare provides coverage for the costs of medical care in the home including help with daily activities if it is part of your doctor's orders. To receive coverage:
- The home health agency you choose must be Medicare- approved.
- You must meet the qualification of your Medicare, Medicare Advantage or MediGap/Medicare Supplemental plan.
In addition to Medicare, there are other state and federal sources for coverage. For example, people with low income may be covered under their local Medicaid program. For those with limited income, there may also be local community programs that assist with daily living needs for seniors or individuals with certain disabilities. The provider you choose will help you apply for the coverage for which you qualify.
How Do I Qualify For Medicare Coverage?
To qualify for home health care, your doctor must write a plan for your home care. In addition:
- You must need at least one or more of the following:
- Part-time nursing care
- Physical therapy
- Speech language therapy
- Occupational therapy
- You must be homebound. This means that leaving your home is a major effort and you seldom do unless, for example, you:
- Attend religious services
- Leave to get medical treatment, including therapeutic or psychosocial care
- You must receive the services from a home health agency that is approved by the Medicare program.
- You may also get care in an adult day-care program that is Medicare approved and state certified to provide adult day care services.
The services are covered by Part A or B of Medicare. You pay $0 for all covered home health visits.
If you have a Medicare Advantage Plan or MediGap/Medicare Supplemental policy, call your plan and ask about your coverage. You may have to use one of the home agencies that they have on contract.
What Do I need To Consider When Choosing a Home Health Agency?
It is important to:
- Choose a home health agency that will meet your personal and medical needs and is affordable. Make sure you choose an agency that is approved by Medicare or is contracted with your Medicare Advantage or MediGap/Medicare Supplemental plan.
- Include your doctor and family members or trusted friends in the process of picking an agency. Ask your doctor, other health care providers, friends, and family for recommendations.
Make a point of checking the health and safety record of the agency before making a choice. Call Medicare and ask them for any reports on the agencies in which you are interested: 1-800-MEDICARE (1-800-633-4227) 24 hours, 7 days a week, including some federal holidays. TTY/TDD users can call 1-877-486-2048. However, the interactive phone system is available 24 hours every day of the year.