Understanding Medicare coverage and what’s covered could make a difference in your overall wellness especially for those who need care at home.
Home health care through Medicare includes a wide range of health and social services delivered in your home to treat illness or injury.
Home health coverage can be an essential resource for Medicare beneficiaries who need health care at home. According to Medicare.gov, when properly implemented, the Medicare home health benefit provides coverage for a constellation of skilled and non-skilled services, all of which add to the health, safety and quality of life of beneficiaries and their families.
If you qualify for the home health benefits, Medicare covers the following:
• Skilled nursing services provide up to seven days per week for generally no more than eight hours per day and 282 hours per week.
• Skilled therapy services such as physical, speech and occupational therapy home health aide, so long as you require skilled care as well.
• Home health aide, so long as you require skilled care as well.
• Medical social services to help with social or emotional concerns related to your illness.
• Certain medical supplies, such as wound dressings and catheters.
• Certain durable medical equipment (DME), such as a wheelchair or walker.
Per Medicare.gov, Medicare should pay for the listed at-home care services regardless of whether your condition is temporary or chronic and regardless of whether your condition is improving or not.
Under the law, Medicare coverage is available for people with acute and chronic conditions as well as for services to improve, maintain or slow decline of an individual’s condition.
A recent report from Nashville, Tennessee-based law firm Bass, Berry and Sims, which examined significant health care fraud, found the federal government saw $2.2 billion in civil fraud recoveries in 2020. Roughly 82% of those settlements and judgments that included about $1.8 billion were from matters related to the health care sector.
DeKalb County Transportation and Council on Aging encourages Medicare recipients to recognize and prevent home health care fraud by remembering the following tips:
• Carefully read your Medicare Summary Notice (MSN) and Explanation of Benefits (EOB) to ensure they accurately reflect the services you received.
• Work with your doctor to enroll in-home health services and determine your plan of care. Do not enroll in-home health services with a doctor you do not know.
• Do not accept gifts like money or groceries in return for home health services.
If you have any questions or suspect Medicare fraud or error, call your State Health Insurance Program (SHIP) Coordinator, Lynn Hixon, at the DeKalb County Council on Aging at 256-845-8590.