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Medicare Coverage of Services at Home

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Are you out of the loop or just confused about what services Medicare will cover when it comes to in-home care for your parents? If so, you are not alone.

It's usually not until Mom or Dad need home care that you are faced with figuring out what services are paid for by Medicare. Primarily, Medicare reimburses home health care for your elderly parents and relatives when they return home after a hospital or nursing home stay for illnesses, injuries, rehabilitation services, and hospice. Let's review a simplified version of Medicare coverage.

Medicare does cover:

Skilled Nursing provided by a licensed nurse (RN or LPN) and through a Medicare certified home health agency. It can only be on a part-time or intermittent basis. This means, without exception, that Medicare will not reimburse nursing care if Mom or Dad needs full-time or continuous nursing care at home. Your parents must also be homebound and under the care of a physician. Be aware that while getting skilled nursing care, your parent is eligible for home health aide visits. In other words, Medicare coverage of personal care services is dependent on your need for skilled nursing care.

Read Medicare's description of skilled nursing coverage

Physical Therapy, Occupational Therapy, & Speech-Language Pathology provided by a licensed therapist and through a Medicare certified home health agency. Mom or Dad need to be homebound and rehab must be ordered by his or her physician. In addition, it must be medically necessary meaning that the therapy is specific, safe and effective for your parent’s condition. Another Medicare requirement (sometimes a gray area) specifies that therapy must be expected to result in improvement of your parent’s condition. Keep in mind that while getting PT, OT, or ST, your parent can also take advantage of home health aide visits to provide personal care.

Read Medicare's description of PT, OT, and SLP coverage

Personal Care provided by a home health aide includes bathing, grooming, toileting, diapering, and skin care for your parents. Home health aide visits at home must be under the supervision of a nurse or therapist to qualify for Medicare reimbursement. Simply put — your Mom or Dad is not eligible for personal care services if that is the only home care service they need. As with nursing and therapy, your parent must be homebound and services must be provided through a Medicare certified home health agency. Be sure to request personal care when available as it is especially beneficial for your parent’s hygiene and overall well-being.

Read Medicare's description of Home Health Services coverage

Hospice & Respite Care encompasses multiple valuable services to care for your loved one suffering with a terminal illness in their home. Hospice care is available for your parent at this difficult time when he or she has a life expectancy of 6 months or less. Another requirement is withdrawing from any treatment to cure their terminal illness, and instead focusing on comfort or palliative care. Although hospice may conjure sad or negative feelings, it can be a genuine benefit to your loved one and family. The plan of care the hospice team creates includes everything from doctor visits, nursing care, aide and homemaker, PT, OT, ST, medical social worker and grief counseling. Respite or short-term relief and support is also welcomed by grateful and worn out family caregivers. Medical equipment and supplies for comfort, safety and convenience are covered too.

Read Medicare's description of hospice and respite care coverage

Transitional Care Management Services are provided by physicians and other health practitioners to your parents within 30 days following a stay in the hospital or nursing home. While this service under Medicare is only a few years old, it was established to smooth the transition back home and reduce re-admissions to the hospital. Regardless of whether services are offered at home or in-office, the focus is on communication among health professionals, home care agencies, and family caregivers. Advice and support, access to useful resources in the community, and education (such as for medication management) are all part of this valuable service covered by Medicare.

Read Medicare's description of transitional care management services coverage

Durable Medical Equipment more simply known as DME refers to items that your parents may need at home specifically for medical reasons and not just for convenience. Durable, as the name implies, means that the devices can be used repeatedly and expected to last at least 3 years. In certain situations, your Mom or Dad will need to rent rather than buy equipment such as with hospital beds, alternating pressure mattresses and oxygen supplies. Be sure your parents find a supplier that participates in Medicare before you get DME from them because that means they must accept assignment. The suppliers not only are to be enrolled in Medicare but required to be “participating” to avoid any unreimbursed extra charges. If suppliers don't accept assignment, there’s no limit on the amount they can charge you.

DME that Medicare covers includes, but isn't limited to:

Air-fluidized beds and other support surfaces (these supplies are only rented)
Blood sugar monitors
Blood sugar (glucose) test strips
Walkers, Canes, Crutches
Commode chairs
Continuous passive motion (CPM) machine
Hospital beds
Infusion pumps and supplies (when necessary to administer certain drugs)
Manual wheelchairs and power mobility devices
Nebulizers and nebulizer medications
Oxygen equipment and accessories
Patient lifts 
Sleep apnea and Continuous Positive Airway Pressure (CPAP) devices and accessories
Suction pumps
Traction equipment

Read Medicare's description of durable medical equipment coverage

When making plans for your aging parents it is equally important to understand what home care services are not covered by Medicare. Time and again, families are surprised and disappointed to learn that non-medical, in-home services are not covered by Medicare. Unfortunately, personal care, housekeeping and meal preparation are often the very services that your parents need the most.

Medicare does not cover:

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