Understanding the Medicare Benefit
Medicare will pay for 100 percent of what is commonly called “Medicare Home Health Services" if the individual or patient requiring services meets certain criteria including:
- The patient is a Medicare eligible beneficiary
- The patient is receiving care from a home health agency, such as Bronson at Home, that has a valid agreement to participate in the Medicare program.
- The patient is homebound or confined to his or her residence, meaning it takes a taxing effort to leave the home.
- The patient is under the care of a physician and receiving services under a plan of care that is established and periodically reviewed by a physician.
- The patient is in need of skilled nursing care on an intermittent basis, or in need of physical therapy, speech/language therapy or has a continuing need for occupational therapy.
What are the “home health” services covered by Medicare?
- Nursing, under the supervision of a registered professional nurse
- Physical therapy, occupational therapy, or speech-language pathology services
- Home health aide services
- Routine and non-routine medical supplies
- Medical social services
What are some examples of skilled care?
- Intramuscular or intravenous injections
- Observation and evaluation of a patient if the probability exists that significant changes will occur which require the intervention of a physician or nurse
- Extensive, complex decubitus (bed sores) or wound care
- Teaching of complex self-care and patient management of the disease process
- Therapy services following orthopedic surgery
What is NOT covered under the Medicare benefit?
- Meals on wheels
- Drugs and biologicals
- Inhalation therapy
- Nutritional counseling
- Hourly care
- Custodial care
- Medication set-ups