The Madness of Medicare
As a Medicare Advocate, for years I have researched Medicare policies so that I canclearly convey them to the public. Whenever I meet with a group or individual, themantra is always the same: Medicare is so confusing! How do I do it? Well, I mustadmit that sometimes the “madness” of it all even gets to me.In my last article, I wrote about Medicare coverage of home health services. Imentioned that Original Medicare requires a 3 day hospital stay for qualification of this type of service. There was a time when that was truth, however, hospitaladmission is no longer required. According towww.medicare.gov:
Home Health Care is skilled nursing care and certain other health careservices you receive in your home for the treatment of an illness or injury.Medicare covers some home health care if:1. Your doctor decides you need medical care in your home, and makes a plan for your care at home, and 2. You need at least one of the following: intermittent (and not full time)skilled nursing care, or physical therapy or speech language pathology services, or a continued need for occupational therapy, and 3. You are homebound. This means you are normally unable to leave homeand that leaving home is a major effort. When you leave home, it must beinfrequent, for a short time. You may attend religious services. You may leave the house to get medical treatment, including therapeutic or psychosocial care. You can also get care in an adult day-care program that islicensed or certified by a state or accredited to furnish adult day careservices in a state, and 4. The home health agency caring for you must be approved by the Medicare program.
So there you have it – straight from the source. Home health coverage is ultimatelydecided by you and your physician. The physician will request coverage byexplaining to Medicare your limitations and overall physical condition by completinga patient evaluation.With certain patients, home health care is not enough. A person may be in such acritical state that she requires round the clock care and supervision. In this case,Long Term Care options are the solution.Home health is an excellent benefit and helps many patients through therapy andsupport services return to their full strength and independence. If you think youmay need this service, talk with your doctor right away. There are many reputablehome health companies in Middle TN waiting to help.
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