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Medicare Home Health Care and Hospice Benefits

What is home health care?

Home Health Care is skilled nursing care and certain other health care services that you get in your home for the treatment of an illness or injury.

How can I get care at home?

To get Medicare home health care:

  1. Your doctor must create a plan for your care at home if determined medically necessary; and
  2. You must need at least one of the following:
    1. intermittent (and not full time) skilled nursing care,
    2. physical therapy
    3. speech language pathology services; and
  3. You must be homebound, and a doctor must certify that you are homebound. To be homebound means the following:
    1. Leaving your home is not recommended because of your condition.
    2. Your condition keeps you from leaving home without help (such as using a wheelchair or walker, needing special transporation, or getting help from another person).
    3. Leaving home takes a considerable and taxing effort.

    A person may leave home for medical treatment or short, infrequent absences for non-medical reasons, such as attending religious services. You can still get home health care if you attend adult day care, but you would get the home care services in your home.

  4. The home health agency caring for you must be approved by the Medicare program.

The Original Medicare Plan covers these home health care services:

Medicare Services Covered

Part-Time or Intermittent Skilled Nursing Care

x

Part-Time or Intermittent Home Health Aide Services

x

Physical and Occupational Therapy

x

Speech Language Pathology Services

x

Medical Social Services

x

Medical Supplies (not drugs or biologicals)

x

Durable Medical Equipment

x*

*The Original Medicare Plan usually pays 80% of the approved amount for certain pieces of medical equipment. You may have to pay 20% of the approved amount for durable medical equipment. Ask your supplier "Do you accept assignment?" Assignment could save you money.

How do I find an approved home health agency?

It is important to remember that your home health agency must be approved by Medicare in order to receive benefits. You can find a Medicare-approved home health agency by:

  • asking your doctor or hospital discharge planner
  • using a senior community referral service, or other community agencies who help you with your health care
  • looking in your telephone directory in the Yellow Pages under "home care" or "home health care." (Look for home health care agencies that say they are Medicare approved.)
  • visitng the Idaho Health and Welfare website

What if I am in a Medicare Advantage Plan?

It is very important to remember: If you belong to a Medicare Advantage plan, your choice of home health agencies may be limited to agencies that contract with or agree to accept the Medicare Advantage plan. Call your plan if you have questions about the plan's home health care rules. If you get services from a doctor or a home health care agency that doesn't work with the  plan, neither the plan nor Medicare will pay the bill.

What does Medicare cover?

Hospice is a program of care and support for people who are terminally ill. Here are some important facts about hospice:

  • Hospice helps people who are terminally ill live comfortably.
  • The focus is on comfort, not on curing an illness.
  • A specially trained team of professionals and caregivers provide care for the "whole person," including his or her physical, emotional, social and spiritual needs.
  • Services may include pysical care, counseling, drugs, eqipment and supplies for the terminal illness and related condition(s).
  • Care is generally provided in the home.
  • Respite care.

How do I receive Medicare hospice benefits?

  • You can get Medicare hospice benefits when you meet all of the following conditions:
  • Your are eligible for Medicare Part A (hospital insurance).
  • Your doctor and the hospice medical director certify that you are terminaly ill and have 6 months or less to live if your illness runs its normal course.
  • You sign a statement choosing hospice care instead of other Medicare-covered benefits to treat your terminal illness. (Medicare will still pay for covered benefits for any health problems that are not related to your terminal illness.)
  • You get care from a Medicare-approved hospice program.

What will I have to pay for hospice care?

Medicare pays the hospice provider for your hospice care. There is no deductible. You will have to pay the following:

  • No more than $5.00 for each prescription drug and other similar products for pain relief and symptom control.
  • 5% of the Medicare-approved amount for inpatient respite care. For example, if Medicare pays $100 per day for inpatient respite care, you will pay $5.00 per day. The amount you pay for respite care can change each year.
Can I keep my Medicare insurance plan?

Yes. Your Medicare supplement insurance or health plan will cover health problems not related to your terminal illness.

How long can I get hospice care?

Hospice care is intended for people with 6 months or less to live if the disease runs its normal course. If you live longer than 6 months, you can still get hospice care as long as the hospice medical director or other hospice doctor recertifies that you are terminally ill.