Medicare is an insurance program run by the U.S. Government. To be eligible for this program, you must be 65 years of age or older, have a qualifying disability or be in end-stage renal failure (permanent kidney failure). Medicare provides a customized online private assessment tool for you to determine your eligibility for this insurance program. Home health care benefits are just one of the many benefits that may be covered for you under the Medicare program. If you are younger than 65 or do not have a qualifying disability, you may still be eligible for U.S. Government-based insurance under the U.S. Medicaid program.

How do I sign up for Medicare?

Confirm your eligibility for the Medicare program using the assessment tool and then use the online Medicare forms (See Resources). Medicare also provides limited coverage for persons needing assistance during the “gap” period before the Medicare policy becomes active.

Types of Medicare Plans

To meet your insurance needs, Medicare offers several insurance programs. The original Medicare program covers many services, but co-payments and deductibles are charged. These charges are known as gaps in coverage. Medicare provides an add-on insurance program called Medigap to provide coverage when gap charges apply. The Medicare drug prescription plan is another option that is available as an add-on to existing coverage. Many Medicare plans do not include coverage for prescription drugs. Medicare Advantage Plus is another type of insurance plan. Several types of insurance options in this program included HMO, PPO, Special Needs service, Medical Savings and Private Fee-for-Service. This program offers a few options that are less costly than the original Medicare program.

Are you eligible for home health care?

If you meet certain qualifications, Medicare may cover your home health care expenses. These qualifications include:

1. physician recommendation
2. physician outlined plan for care
3. need for skilled nursing care, speech therapy, occupational therapy or physical therapy
4. use of Medicare approved home health care agency
5. considered to be home bound and unable to leave home without extreme effort.

What home health care expenses will Medicare cover?

Once you are considered qualified for home health care, Medicare will pay for your home health care expenses. Skilled nursing care is covered for a full-time or part-time basis, but only for services that require a licensed nurse. Home health aide services are covered on a full-time or part-time basis. These caregivers assist in personal care needs such as bathing and dressing. For this care to be covered, you must also be receiving skilled nursing care. Physical therapy will be covered as long as your physician deems it necessary. Medical social counseling services are covered. This service can also assist you in finding treatment care options in your community. Medical supplies and equipment, not including prescription medications, are covered. In certain circumstances, FDA-approved osteoporosis injections are covered expenses.

Which Agencies are Eligible Home Health Care Facilities?

A physician or a hospital can recommend Medicare-approved home health care agencies. You are not required to use these physician or hospital recommendations. There are different levels of care and costs involved in each agency. You have the right to select an agency that you are comfortable with. This agency must be responsible for providing for all of your home health care needs. You cannot use more than one agency for services. Certain communities have senior referral services to assist in your selection of an agency that fits your needs.

Any cost?

Typically Medicare will send a bill directly to the home health care agency for payment. Most costs should be fully covered if you are deemed eligible for care. The home health agency that you select will be familiar with what is covered by Medicare. This agency is required to discuss costs with you and your family before beginning any home health care services.

Other costs?

Medicare has a separate program that covers the expense of prescription drugs. If you are not enrolled in this or any other prescription drug program, you will be eligible for the costs. A 20 percent co-payment is also a usual charge when you need any special equipment such as wheelchairs, walkers, bandages.