Some health care done in a hospital or doctor’s office can now be done at home. It’s effective, convenient and usually less costly.
Medicare might pay for health care you receive in your home. To qualify, you must be homebound, under a physician’s care and need part-time nursing care or rehabilitative services.
“Homebound” doesn’t necessarily mean “bedridden.” But it does mean that you seldom leave home. And when you do, you may require a wheelchair or walker and assistance.
Medicare pays 100 percent for your care as long as you’re eligible. It also pays for 80 percent of any medical equipment you need, like a special bed or oxygen.
One in 10 people with Medicare relies on home health in any given year. About a third of the home visits are for patients released from the hospital but still requiring attention. The other two-thirds are for people trying to stay out of the hospital in the first place.
Your home health care starts with your doctor’s decision that your illness or injury demands it. You may need a skilled nurse to give you IV drugs, shots or tube feedings, change dressings and teach you about prescribed drugs.
You also may require occupational, physical or speech therapy to become as self-sufficient as possible.
The home health agency will work with you and your doctor to plan your services.
To qualify for Medicare’s home health benefit, your nursing care must be part-time. Home health aides who help with bathing and dressing, as well as aides who clean or do laundry, may be covered if they’re part of your overall plan.
Medicare doesn’t pay for 24-hour-a-day care at home or meals delivered to your door. Nor does it cover personal care or housekeeping if that’s all you need.
Before your care begins, the home health agency should tell you about any services or items that Medicare won’t cover and how much you’ll have to pay for them. The agency should inform you about the coverage and costs in writing and by talking with you.
You’ll want to select an agency that’s Medicare-certified. Use Medicare’s Home Health Compare website – at www.medicare.gov/homehealthcompare – to compare agencies in your area.
You’ll find statistics showing how well the patients of particular agencies recover from illnesses or injuries and resume their everyday activities.
In choosing an agency, ask your doctor, hospital discharge planner or social worker for recommendations. And visit with family and friends about their home health care experiences.
Though most home health agencies are reputable, some have been found to commit fraud. If you don’t understand your plan, ask questions.
When your quarterly Medicare summary notice arrives in the mail, check the statement for any services or item that you don’t think you received or used. Fraudulent billing wastes Medicare dollars and takes money that could be used to pay valid claims.
If you’re in Medicare’s traditional fee-for-service program and have questions about your health care benefits and coverage, call Medicare at 800-633-4227. If you’re in a private Medicare Advantage plan, consult your plan.
By Bob Moos, Southwest public affairs officer for the Centers for Medicare & Medicaid Services.
