Your parents, grandparents, or any loved ones near and dear to you are getting older. You’ve been spending a lot of additional time helping them. You’ve been doing things like helping them to get around the house, preparing meals, light housekeeping, reminding them to take their medications, etc. You are a busy person, and only have so much time. You want the best for your loved ones and think it might be nice to have some assistance with the cares you are providing. You think home health care might be the answer.
These types of cares are called Personal Cares or Personal Care Services. In the home health care industry, the workers that provides these services are called Personal Care Workers or Home Health Aides.
Your elderly loved ones have paid into Medicare their whole lives. You know they need these services, and you assume that Medicare will pay for the services. You have called Medicare or the Insurance company your loved ones have a Medicare plan with. They have told you the plan covers a certain number of weekly hours for Personal Care Services. Great!
Yet, they haven’t told you that your loved ones must meet all the Medicare Eligibility Criteria for home health services before Medicare will pay for any Personal Care Services. As of today, the criteria are as follows:
Your loved ones must:
- Need a Skilled Home Health Service
- Nursing – for things like wound care for pressure sores or a surgical wound, Patient or caregiver education, intravenous or nutrition therapy, injections, etc.
- Therapies – physical, occupational, or speech
- Have had a “Face-to-Face Encounter” with your Doctor
- This means they must have an office visit with a Doctor where you specifically talk to the doctor about their need for home health services. The doctor must document on his/her office visit note that you spoke about home health care and the specific reasons Skilled Home Health Services are needed.
- The Doctor must be a Medicare Certified doctor.
- Be “Homebound”
- This means there is a very good reason that your loved one cannot leave home to get the skilled services at an outside facility.
- Have a “Home Health Certifying Statement” from your Doctor
- A doctor must also prepare a statement that is kept with the patient’s medical record. The doctor must certify that the patient qualifies for Home Health Services and make specific statements describing why and how the patient meets all the Medicare Eligibility Criteria. The Doctor must also indicate that he/or she will sign the Home Health Plan of Care.
Only when all the Medicare Criteria for Home Health Care are met, will Medicare pay for any Personal Care Services. It is important to realize that if there is no need for a Skilled Home Health Service, Medicare will not pay for Personal Care Services.
Even if all the Medicare Criteria are met, the amount of Personal Care Services covered by Medicare is usually only around 4 hours a week (two 2-hour visits per week.)
So, the only other options are for your loved ones to privately pay (pay themselves out of pocket), have a long-term care insurance plan, or qualify for Medicaid.
If your loved ones meet the income requirements for Medicaid and have Medicaid health coverage, Medicaid will pay for Personal Care Services.
If your loved ones have a long-term care insurance plan and you have filed a claim, the insurance company will pay for Personal Care Services.
Once a Home Health Agency knows that your loved ones have Medicaid, they will check their eligibility. The Home Health Agency will request an order for your loved ones’ Doctor to do an Assessment for Home Health Care. A Nurse will come to your loved ones’ home, do an assessment, and submit the assessment to Medicaid. Medicaid will then determine how many hours per week of Personal Care Services they will authorize. The home health agency will then start providing services.
If you have filed a claim under a long-term care insurance policy, the insurance company will send a person to assess how many weekly hours of Personal Care Services your loved ones qualify for. The home health agency will then start providing services.
If you are currently providing personal care services for your loved one to the point it is as if it is your job, and your loved one would like you to continue, there are some instances where the home health agency can employ you as the caregiver. You must meet the requirements to be a caregiver and the requirements to be employed by the Home Health Agency.
To sum up, if your loved one needs Personal Care Services, a Home Health Agency can help. One aspect of most Home Health Agencies’ missions is to help those who need help, but cannot easily leave their homes for help. Yet, Home Health Agencies cannot provide free services, but we will work with you. Medicare (no matter what plan you have) will only pay for a very limited amount of Personal Care Services if all the eligibility criteria are met. Yet, if Personal Care Services are needed, don’t give up. There are other options including Medicaid, long-term care, and paying privately. Additionally, there are some instances where you might qualify to be hired by the Home Health Agency to care for your loved one.
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