Does Medicare Cover Home Health Care in Brooklyn?

Medicare is a federal government health insurance program for older citizens aged 65 and above, including people with rare or permanent disabilities such as End-stage Renal Disease (ERSD). However, most seniors often prefer receiving health care services at home for several personal reasons. Hence, home health care is becoming increasingly popular among seniors and is often more expensive (about $25 per hour) than medical care in hospitals.

As a result, people always want to know if Medicare covers their home healthcare needs or those of their family members. The good news is that Medicare has four parts: Parts A, B, C, and D, and Parts A (hospital insurance) and B (medical insurance) make provisions for certain home care services.

Yet, this type of in-home care isn’t for everyone. There are conditions and eligibility requirements to enjoy such a benefit in Medicare, and we shall explore them in detail as you read on.

If you are not sure of your eligibility for home care services or that of your loved one, kindly follow this guide.

Does Medicare Cover Home Health Care?

Yes. Medicare’s health insurance scheme caters to the home healthcare needs of people eligible for the program, including non-medical services for seniors. The goal of the scheme is to provide seniors with short-term skilled medical attention at home instead of in hospitals or healthcare facilities. So, if you or your loved one desires health care services at home, Medicare can accommodate such a demand.

To receive home senior care under the Medicare insurance scheme in Brooklyn, you must meet certain requirements. Your peculiar health situation must also be on the list of special cases that require home care under the program.

Criteria for Home Health Care Eligibility in Medicare

The first eligibility criteria is that; the person must be 65 years of age or older and must have qualified for the Medicare Part A or Part B program. Other conditions include the following:

Finding a home healthcare agency approved by Medicare.
Your home health care demand must be a recommendation from your doctor certifying that your condition requires skilled services or occasional skilled nursing care and not a personal decision.
Your health condition must require assistance from a part-time skilled nurse for regular care and physical, speech, or occupational therapy from a therapist.
Your doctor must be part of the home healthcare plan set up with your healthcare provider. It, therefore, means you must be under the care of a doctor who will plan your treatment needs according to your special health challenge.
Your health situation must be so critical that you are confined to your home without the ability to move around or go outdoors freely. Additionally, a doctor must certify you are homebound, implying you are significantly immobile.
You or your loved one must be receiving or qualify for Social Security retirement benefits.

How Medicare Implements the Home Health Care Program

Medicare will pay in full, your home health care costs under Part A or B of its provisions, regardless of the number of home visits you’ll have. Medicare will also pay to evaluate your home care needs to certify you eligible if a doctor recommends that you need special home care based on your condition.

For Part A (Hospital Insurance), Medicare will be responsible for the costs of your home medical services if they come after you’ve been discharged from the hospital. Otherwise, it falls under Part B (medical insurance).

What Medicare Pays For Under Home Health Care

If you are eligible for home care, Medicare will pay the cost of the following health care services:

Part-time Skilled Nursing Services

Medicare will cover the full costs of the services you receive from a fully licensed, part-time skilled nurse with the right healthcare knowledge to treat your specific condition. These services include administering medications and injections, performing catheter changes, providing injury treatment and care, teaching self-medication, and observing and evaluating your condition for any improvement, among others. However, the skilled nurse won’t provide these services daily or round the clock. Typically, Medicare pays for up to 28 hours of work per week in health care services you receive at home.

Skilled Therapy Services

If you need speech, physical, or occupational therapy while receiving treatment at home, Medicare will cover the costs if it is provided by a skilled and licensed therapist. Also, the required therapy must be part of your treatment plan as prescribed by your doctor and must be effective, safe, and specific. Only qualified therapists are allowed to provide any of the services, and your condition must have the possibility of improving within a certain period.

Here’s how each therapy service helps a senior citizen lead a healthier life:

Speech Therapy: Assists in regaining proper use of the tongue and making clearer, more audible speeches through various exercises. The process also alleviates swallowing difficulties.

Physical Therapy: Assists in regaining proper use of the body’s skeletal structure in movement and other physical activities. The therapy also restores strength and facilitates easy motion from point to point.

Occupational Therapy: Assists in restoring optimal and independent use of the body to work, eat, bathe, and carry out other activities of daily living.

Medical Social Services

Medicare will cover the cost of all social services related to your health challenge, according to your doctor’s recommendation, if the social medical service will help you recover. These services include counseling to help you deal with the emotional damage caused by illness or prevent depression.

Home Health Aide

Along with skilled nursing services, Medicare will cover the costs of the services of home health aides. These services include helping with physical activities like bathing, dressing, walking, eating, cleaning, etc. It’s essential to note that Medicare won’t cover any cost of your personal care if you don’t need skilled care services.

Medicare will also pay for medical supplies and equipment, such as a wheelchair and wound dressings, among other needs. They will pay for this equipment whether your condition is seasonal, temporary, or chronic.

Note: You cannot qualify for a home health care plan if your condition demands more than part-time services. In this case, your doctor will recommend a long-term care medical service outside of what Medicare covers.

What Medicare Won’t Pay For in Home Health Care

Medicare won’t pay for the following:

Delivery of food supplies to your home or meal preparation.
24 hours of daycare services at home
Personal care services like helping with your bath, using the toilet, and walking around are the only care you need.
Services like shopping, laundry, and general home cleaning are unrelated to the services Medicare will cover in costs.
Any care provided by a family member, only home health agencies approved by Medicare.
Custodial care while staying in an assisted living community.

How Long Will Medicare’s Home Health Care Program Last?

The health insurance program is only temporary or intermittent, lasting for less than seven days a week or 28 hours a week. If additional care is required after 60 days, your doctor will certify you again for another home care plan. This system will continue until the doctor certifies that you no longer need special treatment or any care plan.

Note that Medicare home care programs are for seniors who need occasional treatments, not long-term care, and the frequency of treatment will follow Medicare-approved standards. If your or a loved one’s situation is too critical for occasional home care, Medicare is not the right program. The goal of Medicare is to delay a senior’s admission into a skilled nursing facility or senior home, not to eliminate it entirely.

How Much Does Medicare Cover for Home Healthcare?

Medicare would cover as much as necessary, provided the patient is eligible for a Part A or Part B Medicare policy. Seniors won’t pay a dime for home health care services they receive from a Medicare-certified home care agency.

Before the health care service begins, your choice of home health care agency must provide a comprehensive care plan that includes the kinds of services Medicare can cover. Also, the home care agency must provide an Advanced Beneficiary Notice (ABN), a written list of all services and equipment beyond the coverage of Medicare, and any other cost the patient has to incur in the home care program.

Medicare vs. Medicare Advantage: The Difference and How It Relates to Home Health Care

Before we go into how both plans will affect a senior citizen seeking home care, let’s understand the difference between them.

There are two ways people can receive Medicare: through original Medicare and a Medicare Advantage Plan. Both are often confused with each other, but here’s how they differ.

People who receive original Medicare do so under the Federal Government’s health insurance plan. As such, healthcare providers will refer their payments to the government or any approved government agency after rendering services to Medicare recipients.

Conversely, people who receive Medicare services through the Medicare Advantage Plan are not under the Federal Government’s health insurance plan. The federal government pays for Medicare services through a third-party health plan that is responsible for providing the services.

So, the difference is that the government pays directly for original Medicare services but pays through a third-party health care plan for Medicare Advantage Plans.

How It Relates to Home Health Care

The kind of Medicare plan you choose or are eligible for may significantly affect your home care needs. Typically, all original Medicare recipients will have clear access to care from all licensed home health agencies. However, people on the Medicare Advantage Plan may realize that some home health agencies are not included to provide care for them. Overall, people on the original Medicare plan have a fair advantage over those on the Medicare Advantage plan and will receive more care services than others. This is mainly because people on the Advantage Plan receive between $800 and $1200 per month. That range is barely enough to cater to non-medical services at home.

Does Medicare Cover Home Care for Dementia?

With more than 7 million people aged 65 and above suffering from dementia in the U.S., it’s only natural to inquire if Medicare will cover the cost of such medical conditions in-home care. The answer is yes. Medicare will cover the cost of dementia on an intermittent basis because the program is not for long-term conditions. According to the conditions for Medicare home health care eligibility, a doctor must prescribe personal care for dementia before it can cover the part-time cost.

Conclusion

Medicare is the first port of call for most seniors looking to enjoy home care. It’s a federal government healthcare program that caters to the health needs of retired seniors aged 65 and older. But most seniors would prefer home care to stay close to their families rather than being confined to a hospital or nursing facility. Home care is expensive at $26 per hour, which can average up to $4,000 monthly. With this hefty cost, it’s only ideal to look the way of Medicare, which offers home care services with certain conditions and on a part-time basis. Hence, it becomes necessary to understand all conditions and requirements under the two parts (A and B) of Medicare that cater to home care needs.

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