Understanding the Medicare Benefit

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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

 

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