What is Home Care? Home care refers to professional health care provided in the comfort of your home. It is appropriate to seek home care services when a loved one is in need of on-going care that is not easily provided by family or friends, but can easily be provided by medical professionals. These services are delivered at home to patients who are recovering from surgery or a hospital stay, are home bound, disabled, chronically ill, or in need of nursing care, physical therapy, social services, or assistance with activities of daily living.
More and more elderly people are electing to live independently but are still able to receive home care services as needed. Home care provides such independence to continue and allows patients the ability to stay at home rather than in a skilled nursing facility or other institutionalized care, such as a hospital. However, home care is provided to patients of all ages and medical needs.
What is Hospice? When a loved one is faced with a life-limiting illness, hospice care offers them emotional and physical care to allow for the best quality of life. This includes pain and symptom management, caregiver respite, medical equipment, end-of-life planning, and social services.
Who is eligible for Home Care services? Under the terms of Medicare, you must be under the care of a physician who certifies that you meet the following criteria (as found at the Medicare website):
- You must be under the care of a doctor, and you must be getting services under a plan of care established and reviewed regularly by a doctor.
- You must need, and a doctor must certify that you need, one or more of these: The home health agency caring for you must be Medicare-certified.
- Intermittent skilled nursing care (other than just drawing blood)
- Physical therapy, speech-language pathology, or continued occupational therapy services. These services are covered only when the services are specific, safe and an effective treatment for your condition. The amount, frequency and time period of the services needs to be reasonable, and they need to be complex or only qualified therapists can do them safely and effectively. To be eligible, either: 1) your condition must be expected to improve in a reasonable and generally-predictable period of time, or 2) you need a skilled therapist to safely and effectively make a maintenance program for your condition, or 3) you need a skilled therapist to safely and effectively do maintenance therapy for your condition.
- You must be homebound, and a doctor must certify that you’re homebound.
You’re not eligible for the home health benefit if you need more than part-time or “intermittent” skilled nursing care.
You may leave home for medical treatment or short, infrequent absences for non-medical reasons, like attending religious services. You can still get home health care if you attend adult day care.
Note: Home health services may also include medical social services, part-time or intermittent home health aide services, medical supplies for use at home, durable medical equipment, or injectable osteoporosis drugs.
Who pays for services? Services are covered by Medicare, Medicaid, Aetna, Blue Cross, Blue Shield of Utah (Regence), Gentiva Carecentrix, Health Utah, Humana, Infusion Innovations, University of Utah Health Plans and U of U Home Infusion, United Health Care, VA plan Worker’s Compensation, as well as other private insurances. Prior to providing services, we will verify coverage with Medicare or a private insurance carrier. We do accept private pay as well.
Do you have to be hospitalized in order to receive home care? No, home care initiates with a physician’s order which can happen after a scheduled clinic visit or whenever your physician determines there is a need for home care services. This sometimes occurs after a hospital stay but is not limited to being hospitalized.
What services are covered?
Medicare Part B covers the following Homecare Services:
Medicare Part B (Medical Insurance) covers eligible home health services like intermittent skilled nursing care, physical therapy, speech-language pathology services, continued occupational services, and more. Usually, a home health care agency coordinates the services your doctor orders for you.
What will Medicare cover in the home?
Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance) covers eligible home health services like intermittent skilled nursing care, physical therapy, speech-language pathology services, continued occupational services, and more. Usually, a home health care agency coordinates the services your doctor orders for you.
Medicare doesn’t pay for:
If you have any further coverage questions, please ask your insurance provider, visit the Medicare Website at www.medicare.gov, or call us toll-free at 1-800-871-0102. It would be our pleasure to answer any of your questions.