Does Medicare Cover Home Health Aide Services?
Dec 22, 2021
Medicare covers home health services. Depending on the circumstances, Part A or Part B provides coverage. However, beneficiaries must meet eligibility criteria.
Home health primarily involves helping a person receive care in their own home instead of the hospital when it is appropriate.
In many cases, home health costs less and is just as effective as care that a person may otherwise receive in a skilled nursing facility (SNF) or hospital.
For Medicare to pay for home healthcare, a Medicare-certified home health agency must provide the service. People who receive services from a noncertified home health agency will need to pay the costs out of pocket.
In this article, we explain the coverage of home health services under Medicare.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
Deductible:This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
Coinsurance:This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
Copayment:This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
What home health services does Medicare cover?
Medicare covers a variety of home health services for as long as it is reasonable and deemed necessary to treat an injury or illness.
Medicarecoversup to 8 hours of care a day for a maximum of 28 hours a week. For some people, the insurance program pays for up to 35 hours a week of home health. Medicare assesses the need for 35 weekly hours of care on a case-by-case basis.
Medicare covers the following services:
Rehabilitation therapy
Rehabilitation services help an individual regain daily function and improve their ability to live independently every day.
These services may include physical, occupational, and speech therapy.
Medical supplies and equipment
Medicare Part B covers certain medical supplies that are necessary for home health services. A doctor must prescribe the equipment for Medicare to provide coverage.
Medical supplies and equipment that Medicare covers may include:
canes
infusion pumps
walkers
wheelchairs
hospital beds
blood sugar testing strips and monitors
nebulizer equipment
traction equipment
wound dressings and supplies
Medicare covers the cost of medical equipment for home use in a few different ways, depending on the type of supplies or equipment.
For example, Medicare pays rental costs for certain types of equipment. Patients may choose to buy the equipment, in which case, Medicare also covers the cost.
Medical social services
These services involve assistance from a social worker or counselor. They can help people deal with emotional issues that may be presenting barriers to recovery from an illness or injury.
Skilled nursing care
Medicare Part A also covers the provision of skilled nursing care through home health if it is intermittent or part-time.
Intermittent nursing involves under8 hoursof care a day for 21 days or, in some circumstances, up to 35 days. It can also refer to nursing care that a person receives on fewer than 7 days of the week.
Medicare does not cover skilled nursing care that requires more than 8 hours a day or is not intermittent.
A registered nurse or licensed practical nurse must provide skilled nursing during home health services for Medicare to pay. Home health skilled nursing care may include:
wound care and dressing changes
tube feedings
administering intravenous (IV) drugs
education in disease management
Home health personal care
Home health aides provide personal care, such as help dressing and bathing.
Medicare only pays for a home health personal care aide when an individual also receives skilled nursing care or rehabilitation services through home health. Medicare does not cover home health personal care aides as a stand-alone service.
Other Articles You May Like
Winter Wellness for Seniors
Winter Wellness for SeniorsBy Patrick Troumbley, MS, CSCSBalancing the 8 Pillars of Wellness for Seniors in Winter: Evidence-Based Insights Introduction As winter descends, the well-being of seniors becomes a paramount concern. Aging individuals must navigate the unique challenges that colder temperatures and reduced daylight hours bring. This article delves into the intricacies of balancing the 8 pillars of wellness for seniors during the winter season, substantiating insights with scholarly references. Physical Wellness Physical wellness, a cornerstone of senior health, demands careful attention during winter. Maintaining physical activity is essential for avoiding the adverse effects of inactivity and cold weather. A study by de Rezende et al. (2014) emphasizes the importance of regular physical activity for seniors, citing its role in reducing the risk of chronic diseases. Indoor exercises like yoga and chair exercises, as recommended by the American Heart Association (2021), offer viable options to stay active during winter. Mental Wellness The winter months often usher in feelings of isolation and seasonal affective disorder (SAD). A study by Melrose (2015) underscores the prevalence of SAD among older adults. Engaging in cognitive stimulation activities can alleviate symptoms. Seniors can find solace in local clubs, virtual classes, and community events, as advocated by Forrester (2017), who highlights the significance of social engagement in mitigating SAD symptoms. Emotional WellnessEmotional wellness hinges on effective emotional regulation. Mindfulness and relaxation techniques are integral components of emotional wellness. A systematic review by Rusch et al. (2019) supports the efficacy of mindfulness-based interventions in reducing stress and anxiety. Seniors can access mindfulness resources and guidance on emotional wellness through organizations such as Seniors Blue Book Utah. Social WellnessMaintaining an active social life is pivotal for seniors. The adverse effects of social isolation on senior well-being have been extensively documented (Holt-Lunstad et al., 2015). Seniors are encouraged to participate in local clubs and community events, as promoted by Senior Expos, to foster social connections. Intellectual Wellness Intellectual wellness necessitates ongoing learning and mental stimulation. Seniors can embrace hobbies like reading and learning new languages to foster intellectual growth. A study by Verghese et al. (2003) associates intellectual engagement with a reduced risk of cognitive decline in aging individuals. Occupational Wellness Occupational wellness transcends traditional work and relates to engaging in purposeful activities. Volunteering, as explored in a study by Okun et al. (2016), offers seniors a sense of purpose and fulfillment. Seniors can explore volunteer opportunities through organizations like Seniors Blue Book Utah. Environmental Wellness Winter introduces environmental challenges, such as slippery sidewalks and heating concerns. Seniors must ensure their living environments are safe and comfortable. The National Institute on Aging (2021) provides valuable tips for creating senior-friendly environments. Spiritual Wellness Spiritual wellness revolves around finding meaning and purpose in life. Engaging in spiritual practices, such as meditation and prayer, can provide solace and inner peace. A study by Carlson et al. (2016) explores the positive effects of mindfulness-based spiritual practices on well-being. Conclusion Balancing the 8 pillars of wellness is paramount for senior well-being, especially during the winter months. Evidence-based insights emphasize the need for regular physical activity, cognitive stimulation, social engagement, and emotional regulation. Seniors can access resources and information from reputable organizations like Seniors Blue Book Utah and Senior Expos to aid in their pursuit of wellness. By integrating these scholarly insights into their winter routines, seniors can not only survive but thrive during this season, enjoying a life marked by health, happiness, and purpose. References: American Heart Association. (2021). Recommendations for Physical Activity in Older Adults. https://www.heart.org/en/healthy-living/fitness/fitness-basics/aha-recs-for-physical-activity-in-older-adults Carlson, L. E., et al. (2016). Mindfulness-based interventions for coping with cancer. Annals of the New York Academy of Sciences, 1373(1), 5-12.de Rezende, L. F. M., et al. (2014). Physical activity and preventable premature deaths from non-communicable diseases in Brazil. Journal of Public Health, 36(3), 514-522. Forrester, A. (2017). Seasonal affective disorder in older adults: improving mood and well-being through leisure interventions. Activities, Adaptation & Aging, 41(1), 39-53. Holt-Lunstad, J., et al. (2015). Loneliness and social isolation as risk factors for mortality: A meta-analytic review. Perspectives on Psychological Science, 10(2), 227-237.Melrose, S. (2015). Seasonal affective disorder: An overview of assessment and treatment approaches. Depression Research and Treatment, 2015, 1-6.National Institute on Aging. (2021). Winter Safety Tips for Older Adults. https://www.nia.nih.gov/news/infographics/winter-safety-tips-older-adults Okun, M. A., et al. (2016). Volunteering by older adults and risk of mortality: A meta-analysis. Psychology and Aging, 31(6), 634-645. Rusch, H. L., et al. (2019). A randomized controlled trial of the effects of mindfulness-based stress reduction on posttraumatic growth among survivors of interpersonal violence. Journal of Traumatic Stress, 32(6), 936-946. Verghese, J., et al. (2003). Leisure activities and the risk of dementia in the elderly. New England Journal of Medicine, 348(25), 2508-2516.Patrick Troumbley, MS, CSCS
June is Alzheimers & Brain Awareness Month: Learn 10 Ways to Love Your Brain
June is Alzheimers & Brain Awareness Month: Learn 10 Ways to Love Your BrainThis June, during Alzheimers and Brain Awareness Month, join the Alzheimers Association to help raise awareness of this devastating disease. You can start by learning and sharing 10 Ways to Love your Brain.Nearly seven million people in the United States, including 34,000 Utahns, are living with Alzheimers disease. The seventh-leading cause of death and the only leading disease without a prevention or cure, Alzheimers kills more Americans every year than breast cancer and prostate cancer combined. When possible, combine these habits to achieve maximum benefit for the brain and body:1. Break a sweat: Engage in regular cardiovascular exercise that elevates your heart rate and increases blood flow to the brain and body. Several studies have found an association between physical activity and reduced risk of cognitive decline.2. Hit the books: Formal education in any stage of life will help reduce your risk of cognitive decline and dementia. For example, take a class at a local college, community center or online.3. Butt out: Evidence shows that smoking increases risk of cognitive decline. Quitting smoking can reduce that risk to levels comparable to those who have not smoked. 4. Follow your heart: Risk factors for cardiovascular disease and stroke obesity, high blood pressure and diabetes negatively impact your cognitive health. Take care of your heart, and your brain just might follow.5. Heads up: Brain injury can raise risk of cognitive decline and dementia. Wear a seat belt, use a helmet when playing contact sports or riding a bike, and take steps to prevent falls.6. Fuel up right: Eat a healthy and balanced diet that is lower in fat and higher in vegetables and fruit to help reduce the risk of cognitive decline. Although research on diet and cognitive function is limited, certain diets, including Mediterranean andMediterranean-DASH (Dietary Approaches to Stop Hypertension), may contribute to risk reduction.7. Catch some ZZZs: Not getting enough sleep due to conditions like insomnia or sleep apnea may result in problems with memory and thinking.8. Take care of your mental health: Some studies link a history of depression with increased risk of cognitive decline. Seek medical treatment if you have symptoms of depression, anxiety or other mental health concerns. Also, try to manage stress.9. Stump yourself: Challenge and activate your mind. Build a piece of furniture. Complete a jigsaw puzzle. Do something artistic. Play games, such as bridge, that make you think strategically. Challenging your mind may have short- and long-term benefits for your brain.10. Buddy up: Staying socially engaged may support brain health. Pursue social activities meaningful to you. Find ways to be part of your community if you love animals, consider volunteering at a local shelter. Enjoy singing? Join a local choir or help at anafterschool program. Or, just share activities with friends and family. Its never too late or too early to start thinking about your brains health making healthy choices at any age is beneficial. Visit alz.org/10ways to learn more.