You won’t be surprised to know that one of the most common questions we get from our clients (and potential clients) is “who’s going to pay for this?” While in-home care is usually much less expensive than staying in a hospital, we can’t deny that it’s still a considerable outlay of funds to pay for home healthcare. Who’s going to pay for it? What are the conditions? That’s what we’re going to take a look at today.

In most cases, those needing home healthcare service can get care for up to 60-days, and almost everything is covered at 100%. Still, before you can start getting this type of care, you have to qualify. Here are some of the criteria that need to be met.

What Services Are Covered?

A doctor needs to certify that you are in need of one of the following services:

Skilled Nursing Care – Along with elder care services and senior companion care, this is the primary service we offer. Our certified nurses provide help with intensive home health services such as cardiopulmonary rehab, negative pressure wound therapy, IV infusion, neurological rehab and many more post-surgery treatments. Most anything that involves a significant and recent medical condition will be allowed.

Physical Therapy –  Physical therapy is most often used by those needing help relearning to use muscles after an accident or brain injury.

Speech Pathology – Speech pathology is often used to help people learn to speak again after a stroke or other brain injury.

Occupational Therapy – Occupational therapy helps people learn how to be self-sustaining and make the most of their living environment after an injury.

Your Doctor Needs To Be Involved

In order to be eligible for Medicare for your in-home healthcare services, you must be under the care of a doctor. She or he needs to be involved in the plan and review it regularly to ensure that it is taking place and that it is being performed according to specific instructions.

As a premier home healthcare agency, we will work with your doctor so that you’re both satisfied that you will be getting the same level of care at home as you would be at a hospital. Our nurses aren’t your primary caregiver but are there to provide care as dictated by your doctor.

The Doctor Says That You’re Homebound

At-home care is just that: at home. It is meant for people who do not have the ability to readily leave the house and have daily medical services performed.

Notice that we used the word readily above. There is some leniency in the idea of homebound, because Medicare doesn’t want to force someone out of the house every day if that would put them in extreme discomfort or it could be detrimental to their health. Simply contact us and we can discuss whether or not we believe that a doctor would consider you homebound. We can also discuss the situation directly with your doctor.

The Home Health Agency Must Be Certified

It is a legal requirement that the home care agency needs to be certified. Any agency that isn’t certified is not allowed to make the claims on your behalf to Medicare. Trust us, this is a good thing; you want someone who’s an actual nurse working for you!

We’re happy to report that Specialized Nursing Services is indeed certified to perform at-home care that is covered by Medicare. If you’d like to know more about our certifications, simply contact us via this page or give us a call.

There Needs To Be An Expected Endpoint

At-home healthcare is not intended to be long term. If it were, then most people would simply have a 100%-paid-for nurse all the time for the rest of their lives. It’s not meant to provide the same services as a nursing home would.

The length of most home health services is usually capped at 60-days. If a doctor doesn’t believe that this care will be done within that “expected endpoint,” it might not be approved in the first place. (There are exceptions to every rule; we can work with you and your doctor to help determine this.)

Is Everything Covered?

While our next blog will discuss what isn’t covered by Medicare, we’re happy to tell you that medical supplies and medical social services are all covered during such care. In most cases, there are also no co-pays or deductibles to meet.

Please understand that the above criteria are just basic guidelines in order to give you an idea of how the process works. You should always contact a professional directly to find out if you will be covered for a particular treatment. The rules and laws are changing all the time, and certain exemptions are bound to occur from time to time. Still, it’s always worth investigating whether or not you’ll be covered by Medicare, so be sure to click that link to find out. We hope to work with you soon!

If you or a loved one are in need of in-home care services, contact us today.

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