In this guide 6 sections
If leaving home after surgery will be difficult, ask the hospital discharge planner or treating provider to arrange home health before discharge. Original Medicare may cover physical therapy and limited aide help at home when you are homebound and need part time or intermittent skilled services.
Can Medicare cover both physical therapy and bathing help?
Yes. Medicare covered home health can include physical therapy. It can also include part time or intermittent aide care for bathing, grooming, walking, feeding and changing bed linens. Aide care is covered only while you are also receiving skilled nursing, physical therapy, occupational therapy or speech-language pathology services.
What must happen before home health starts?
- 1.Ask a doctor or another eligible health care provider to confirm that you need home health care and place the order.
- 2.Ask the provider to document why leaving home is difficult and requires considerable effort, help from another person, special transportation or mobility equipment.
- 3.Make sure the referral goes to a home health agency certified by Medicare.
- 4.Ask the agency whether physical therapy and bathing assistance are both included in the care plan. Before care starts, the agency should explain what Medicare will pay and identify services that may not be covered.
What does homebound mean?
You generally must have trouble leaving home without help because of an illness or injury, and leaving must require considerable effort. You may still leave for medical treatment and for short, infrequent nonmedical trips.
What help will Medicare not cover?
Medicare does not cover round the clock home care, meal delivery or homemaker services such as shopping and cleaning when they are unrelated to the care plan. It also does not cover bathing, dressing or other personal care when that is the only help you need.
How much aide care can Medicare cover?
In most cases, skilled nursing and home health aide services can total up to 8 hours a day and 28 hours a week. A provider may approve up to 35 hours a week for a short period when necessary. These limits do not mean that every person will receive that many hours.
What if you need more help than Medicare covers?
Call the Eldercare Locator at 1-800-677-1116 to connect with local aging services and community programs. For help confirming Medicare coverage or handling a denial, call 1-800-MEDICARE at 1-800-633-4227 or contact your State Health Insurance Assistance Program for free counseling.
Questions families ask
How much do covered home health services cost under Original Medicare?
You pay nothing for Medicare covered home health services. If the agency provides medical equipment, the Part B deductible and 20 percent coinsurance may apply to the Medicare approved amount.
Can I leave home and still qualify as homebound?
Yes. Medicare allows trips for medical treatment and short, infrequent absences for nonmedical reasons. You must still meet the homebound requirements.
Will Medicare keep paying for a home health aide after physical therapy ends?
Only if you are still receiving another qualifying skilled service, such as skilled nursing, occupational therapy or speech-language pathology. Medicare does not cover personal care when it is the only care needed.
What should I do if the agency says Medicare will not cover a service?
Ask the agency to explain the decision in writing. It should provide an Advance Beneficiary Notice before giving services or supplies that Medicare is not expected to cover. You can also call Medicare or ask your State Health Insurance Assistance Program for help with a complaint or appeal.
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