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When MEDICARE Home Health Care Benefits are not Enough

Medicare does NOT cover in-home companion care or most other types of hourly personal care services. The services covered by Medicare are complicated, but, basically Medicare covers in-home skilled nursing services; physical, occupational and speech therapy; plus some other occasional home health aide services.

If your clients need assistance with one or more of the activities listed below, which are typically not covered by Medicare, contact a home care company. Hourly home care services allow clients to maintain independence in the safety and comfort of home. Our staff is available to answer your questions and help deliver the companion/homemaker or personal care services your clients need.

Companion/Homemaker Services

-Preparing meals

-Medication reminders

-Laundry & light housekeeping

-Driving for errands or doctor visits

-Companionship & socialization

and many more…

Personal Care Services

-Companionship

-Personal hygiene, including bathing and dressing

-Toileting and incontinence care

-Transferring to a bed or chair

-Walking

-Feeding



Source: Right at Home

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About the Medicare Home Health Benefit


If you are a Medicare beneficiary (who is enrolled in Part A, Part B, or both), Medicare will help cover your home health care, if you meet the following four (4) conditions:

A doctor must decide that you need skilled care in your home and prescribe or order home care. The doctor, patient, family member, or other caregiver then contacts a home health agency. The home health agency goes to the patient's home, makes an assessment and develops a plan of care, which must be approved and signed by the patient's physician; and

You must need at least one of the following services: part-time or intermittent skilled nursing care or physical therapy, speech-language services, and

You must be homebound. This means that you are normally unable to leave home without considerable and taxing effort, and, when you do leave home, you require the assistance of another person or an "assistive" device, such as a walker, cane, or wheelchair. You may leave home at any time for medical care, approved adult day care or religious services. Absences from home for any other reason must be infrequent or for short periods of time, such as family events or outings; and

You must receive your services from a home health agency that is "certified" (or approved) by Medicare.
If you meet all four of the conditions above, Medicare will help cover:

Skilled nursing. This is care that can only be delivered safely by a registered nurse, or a licensed practical nurse under the supervision of a registered nurse. It is care like injections and complex wound care.

Home health aide services. These services include help with personal care such as bathing, using the toilet, or dressing. Medicare does not cover them unless you are also getting skilled care such as nursing or other therapy.

Therapy. This includes physical therapy, speech-language services and occupational therapy. Your doctor must say you need these types of care.

Medical social services. This is counseling to help with social and emotional concerns related to your illness.
Certain medical supplies. This includes things like wound dressings and ostomy supplies.

Certain durable medical equipment. This includes wheelchairs, hospital beds, oxygen and walkers (not all home health agencies provide equipment — and, if they do, you will be responsible for paying 20% of the cost of these items).

Medicare does not pay for:

24-hour per day care in the home.
Prescription drugs (with a few exceptions — consult your physician).
Meals delivered to your home.
Homemaker services like cleaning, laundry and shopping.

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