Does Medicare Cover Home Healthcare?
At-Home Healthcare Insight Medicare Beneficiaries Need to Know
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Home Healthcare & Medicare
In the United States, health services for the elderly are covered primarily by funds from Medicare (federally supported partial sickness insurance for the elderly), Medicaid (health assistance program for the underprivileged, paid for by local authorities , state and federal), Veterans Health Administration, private Medicare insurance and refundable payments. All states have a state health insurance assistance program, and patients can contact the program for assistance in understanding and choosing a Medicare plan, understanding financial issues, and handling payment denials or appeals.
Physicians understand basic Medicare rules. They will also provide documentation to determine if patients can receive these benefits. So let’s learn more about eligibility for Medicare in this sphere of medicine. But if you still have questions please feel free to call us, for free, anytime at (888) 352-6672 and we will help ensure you’ve got the right Medicare plans for comparison.
What is home healthcare?
One of the significant advances that has been implemented in the health sector is home health care. A service that is provided at home, in the workplace or wherever the patient is, 24 hours a day, becoming a fundamental element because it can mean saving their life.
The care and treatment offered by a doctor to a patient, in the place where he is and during the transfer to the health institution (if it is the case), determines the prognosis of many pathologies and allows to provide adequate care at the moment timely because the medical team is able to intervene in a health situation, giving the patient the opportunity to live.
Additionally, this service prevents people from traveling to clinics and hospitals where they can be exposed to diseases, viruses and bacteria, as well as avoiding travel for consultations on issues that in many cases can be resolved at home.
Eligibility
The following groups can benefit from Medicare:
- US citizens ≥ 65 years eligible to receive benefits from Social Security, retirement (retirement) of the Civil Service (Civil Service Retirement) or Railroad Retirement Board (Railroad Retirement).
- People of all ages with end-stage kidney disease requiring dialysis or transplantation or with amyotrophic lateral sclerosis
- People < 65 years old and have been receiving Social Security disability benefits (or certain Railroad Retirement disability benefits) for ≥ 24 months
How old do you have to be to qualify for Medicare?
Patients 65 and older are eligible for health care coverage under the federal Medicare program. Some exceptions are made for patients under the age of 65 who have certain underlying conditions or disabilities, such as end-stage renal disease or ALS (Lou Gehrig’s disease). Patients under the age of 65 who have already claimed Social Security Disability Insurance (SSDI) for two years may also be eligible for early enrollment in Medicare.
When is the enrollment period for Medicare?
Generally speaking, patients have a seven-month enrollment period during which they can apply for Medicare coverage. The Medicare enrollment period opens on the first day of the month, three months before you turn 65, and closes three months after the month you turn 65.
It is important to understand that Medicare’s open enrollment period, which generally falls in the latter part of the year, does not allow patients to apply for Medicare for the first time. Instead, this period offers current Medicare patients the opportunity to re-evaluate their plans and, if they wish, to make adjustments to their coverage.
Does Medicare cover the care of the elderly?
Divided into several different parts (Part A, Part B, etc.), Medicare provides coverage for some of the most essential health care needs for seniors, including:
- Preventive screenings for cancer, cardiovascular disease and more
- Lab tests
- Imaging studies
- Vaccines and immunizations
- Annual routine visits
- Prescription drugs
- Hospital care
- Ambulatory care
- Home health care services
- Hospice care
- Medical equipment and supplies
- Certain tests and services, like custodial care, are not covered by Medicare.
In general, Part A of Medicare covers certain home health services (e.g., part-time or intermittent skilled nursing, home care services incidental to skilled care, home infusion therapy) if they are part of a plan of care approved by the physician in a bedridden patient. A prospective payment system limits the amount and duration of coverage; however, the annual limits for physical therapy, speech therapy, and occupational therapy have been removed. Medical supplies are covered when run by a home health agency.
Medicare Part D is the specific plan that covers prescription drugs. You can enroll in Part D in order to get the best coverage on your prescription drugs, but be careful that you understand the rules. Part D includes avoidable penalties, but sometimes those fees are worth it – depending upon the situation.
Assistance in activities of daily living, such as eating, dressing, going to the bathroom and sanitation, by inexperienced personnel is only covered at home when specialized care is also required (services of a professional nurse or therapist in a plan home care authorized by a physician). This type of supportive care is covered in a nursing home when it is part of acute post-hospital care or rehabilitation.
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A licensed insurance agent from our team will contact you to discuss your Medicare options.
