Medicare covers home health care services (HHS) to elderly individuals in need of medical assistance after an injury or an illness. This coverage may allow the individual to get the care they need at absolutely no charge. However, it is important to become familiar with who qualifies for in-home care and how the process works.
Whether you have recently fallen and subsequently sustained an injury or have developed a health condition that requires additional medical assistance, you can get the treatment that is necessary while staying in the comfort of your own home by following the proper steps to ensure you qualify.
Of course, the process may look slightly different for each individual. It is helpful to know what services Medicare and Medicaid will cover and what services are not covered as it relates to in-home care. This allows patients to make the necessary financial arrangements if their insurance does not cover 100 percent of the cost for the services required.
Although the process is unique to everyone, there are certain steps that one can expect to go through during the application. The following overview explains the process of applying for in-home care due to a physical need as a result of an injury or an illness.
Application Process
Everyone has a unique experience when it comes to the in-home care application process for Medicare coverage. It depends on a range of factors, including the type of Medicare or Medicaid coverage needed, whether or not the individual has a Medicare Advantage plan and the specific needs they require.
The three main steps those who are in need of in-home care should take include receiving a referral from a doctor, ensuring they are eligible based on their Medicare coverage and need, and determining what skilled-health care needs they have. The following is an in-depth review of each step of the qualification and application process.
Doctor’s Referral
The first step is to have a need for in-home care. The second step is to have the need for in-home care verified by a medical professional. Medicare requires patients who are applying for in-home care to be what Medicare refers to as “homebound.” This means that the applicant has trouble leaving their home or is unable to leave their home without assistance. Most often, one is considered homebound either due to an injury or illness.
A doctor should also certify that the applicant has a need for intermittent skilled nursing care. This means that the applicant requires the assistance of a medical professional to help with their medical needs, which might include administering medication, getting physical exercise as part of a recovery plan and other related activities.
However, Medicare does not cover long-term custodial care. This includes services not related to medical treatment, such as meal delivery, house cleaning, etc. Applicants should factor in the separate cost of these services when determining how much they will need for in-home care.
Check Eligibility for Medicare or Medicaid
The in-home care provider must be considered a Medicare-approved agency. After approval from Medicare or Medicaid, you can search for the in-home care provider that is right for you through their website or through an independent search. Medicare has a list of specific services covered, which include but aren’t limited to:
Occupational therapy
Physical therapy
Speech-language pathology
Social services
Medical supplies
Be sure to check with the in-home care provider that you choose about what costs Medicare will cover. The patient may be required to cover a small percentage of the cost for durable medical equipment, although in many cases they are not responsible for any cost.
When choosing the right in-home care provider that is approved for Medicare and Medicaid, there are important factors to consider. Be sure to choose a provider that lives near your residence. This ensures they can make it to you in time for all of your needs and arrive quickly for more urgent matters. You will also want to verify that they have the staff and resources you need as part of your specialized care plan.
Specialized Plan of Care
The final step of the in-home care application process is to determine your needs. Of course, you will not have to do this alone. Your primary care physician, along with others involved in your medical treatment, can work with the in-home care provider to determine the best way to get you the care you need.
Medicare covers most essential healthcare services temporarily during the recovery and treatment process for illnesses and injuries. This may include helping with administering necessary medication, physical therapy and much more. Each plan of care is tailored to meet the precise needs of the patient so that they can experience the least amount of discomfort during the recovery process and get the medical treatment, attention, and monitoring that they need.
It is important to remain transparent when describing your care plan for insurance purposes. The in-home care provider should offer a detailed explanation as to what services are covered and what costs the patient may be responsible for.
As discussed, most essential services are covered, but certain services not directly related to the patient’s health and recovery are not. Services that will likely not be covered through Medicare insurance include custodial services and transportation services. Patients may also be responsible for the partial cost of necessary medical equipment.
Begin In-Home Care with Comfort Home Care
To learn more about in-home care and the application process, reach out to our team at Comfort Home Care today. We offer in-home care to those in need of additional assistance due to an injury or illness.
Our team is friendly and will be glad to answer any questions that remain about in-home care, Medicare, and the application process. We believe everyone should have the opportunity to get the care they need to manage their physical symptoms and improve their overall health and well-being, and we are here to help through in-home care services.
