What
Medicare Covers
Medicare will help cover home health care costs
for people with Medicare who meet the following four conditions:
• Your doctor must decide you need medical
care at home and make a plan for your care at home.
• You must need at least one of the
following: intermittent skilled nursing care, physical therapy,
speech-language therapy, or continue to need occupational
therapy.
• You must be homebound. This means
that you are normally unable to leave home unassisted. Being
homebound means that leaving is a major effort. When you
leave home, it must be to get medical care, or for short,
infrequent, non-medical reasons such as a trip to get a
haircut, to attend religious services, or adult day care.
• The Medicare program must approve
the home health agency caring for you.
What Is Skilled Home
Health Care?
You may have heard the term “home care”
used to describe a variety of services, from wound treatment
to meal and laundry service. Skilled home
health care, however, is very specific, and usually prescribed
by a physician. Skilled home health care patients require
the services of a licensed health care professional such as
a medical doctor, nurse or therapist. The services can be
for either a short or long period of time. Perhaps most important,
home health care services are usually eligible for Medicare/Medicaid
or other private insurance payment if certain requirements
are met.
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Who Decides If I Need
Skilled Home Health Care?
Usually, your physician will decide if this
care is right for you. If so, he or she will develop a “plan
of care” that describes your health needs and what care
or treatments we can provide for you. This care plan is an
important part of the quality of care we provide. It ensures
that you and your family understand exactly what we plan to
do for you and your role in getting better.
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Who Pays For Skilled
Home Health Care Services?
Medicare, Medicaid and managed care/insurance
plans cover many of the health care services provided in the
home. Medicare, and in some states, Medicaid, will not pay
for personal care services, such as personal aides, unless
skilled nursing services or physical therapy is also provided.
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Who Coordinates My Care
Plan?
Generally, a home health registered nurse or
therapist will coordinate your plan of care under the direction
of your doctor. His or her job is to make sure you are informed
and educated about your condition in addition to providing
services such as intravenous drug administration, medication
management, wound care or post surgical rehabilitation. Specialists,
just like in the hospital, may provide very specific services.
It is your unique plan of care that defines which of the specialists
and other home health care staff will be needed to provide
you with the necessary treatment or services.
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