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?

• Transportation
• Housekeeping
• Meals on wheels
• Drugs and biologicals
• Inhalation therapy
• Nutritional counseling
• Hourly care
• Custodial care
• Medication set-ups