Granted, any government program can be tough to navigate.
And Medicare is no exception.
That noted, a recent Kiplinger's article de-mystifies the Medicare rules when it comes to home health care.
The article is appropriately titled “Medicare Rules for Home Health Care.”
Given your question, you likely are aware that Medicare home health coverage can be vital for seniors.
This is especially true for those recently sent home from the hospital or suffering from a chronic condition and have trouble leaving home. Even so, taking advantage of this benefit can be a real challenge.
For its part, Medicare covers in-home services, including skilled nursing and physical therapy. If a patient is eligible, there is typically no charge and no limit on the length of time they can receive the benefit.
For example, Medicare's requirement that patients be "homebound" is often incorrectly interpreted as meaning that a person who occasionally leaves home is not eligible. This confusion over the rules results in some patients never seeking care because they think they will not qualify.
And those who do seek care may be wrongfully denied care or see their services terminated prematurely.
According to the patient advocates, there is a great deal of subjectivity in some of the rules governing home health benefits.
To qualify for Medicare, you must require part-time skilled nursing, physical or occupational therapy, or speech-language pathology. In addition, these services must be provided by a Medicare-certified home health agency and under a care plan established by your doctor. Finally, a doctor must certify that you are homebound, but this is not as restrictive as many people believe as noted above.
Under Medicare's "homebound" rules, your illness or injury must cause you to have trouble leaving your home without help—like using a walker or special transportation—or must make leaving home difficult and medically unadvisable because of your condition.
Things like occasional religious services or health care visits do not disqualify a person from being “homebound.” It does not mean "bedbound" and some Medicare Advantage plans waive the homebound requirement entirely.
Home health care should keep going as long as you are eligible.
Unfortunately, the services of some patients have been terminated because their condition is not improving even though the rules do not require this.
In fact, Medicare beneficiaries filed a nationwide class action lawsuit in 2011 arguing that providers were inappropriately applying an improvement standard. Even though that case settled in 2013 with the understanding that patients should be able to get care to maintain their condition or even slow their decline ... but the misperception persists.
If a person believes his or her home health care is being wrongfully denied or ended prematurely, this individual can file an appeal. When a home health agency suspends care, it must provide written notice that includes the rationale for ending care and contact information for a Quality Improvement Organization, a group of health-quality experts who will review your appeal.
Know your rights and contact an experienced elder law attorney to help when needed.
Remember: “An ounce of prevention is worth a pound of cure.” When making your financial, tax and estate plans, do not go it alone. Be sure to engage competent professional counsel.
For more information about estate planning in Overland Park, KS (and throughout the rest of Kansas and Missouri), visit our estate planning website and be sure to subscribe to our complimentary estate planning e-newsletter while you are there.
Reference: Kiplinger’s (June 2016) “Medicare Rules for Home Health Care”