Eighty-four percent of Medicare beneficiaries are 65 or older.
Medicare is a national health insurance program designed mainly for older citizens of the United States. Most people who qualify for Medicare are aged 65 years or older. Nevertheless, if you're younger than 65 you may also qualify if you have specific health conditions. Original Medicare, often referred to as Part A and Part B, provide benefits for services such as home health services and hospice care performed at home. But the Centers for Medicare & Medicaid Services sets certain conditions which must be met for Medicare to cover these services.
Part A
Before you can receive home health benefits, you must enroll in Part A Medicare. Beneficiaries can't enroll in other parts of Medicare without first having Part A. Part A is hospital insurance since it mostly offers inpatient treatment. But Part A also carries the benefits for health and hospice care. Part A may be provided by the government free of monthly premiums. If you don't qualify for this kind of Part A, however, you may be able to join by paying a monthly charge. How much your Part A premium is depends on how many quarters of employment you have where you paid into Medicare. As of 2010, if you have less than 30 quarters, your premium is $461 per month. If you have 30 to 39 quarters, the Part A premium is $254.
Medicare Benefits for Home Health
After enrolling in Part A Medicare coverage, you're eligible for home health benefits. Medicare will cover home-based therapy, skilled nursing care and social services. If you become terminally ill, once you enter the last six-months you can also receive palliative nursing care, medications, necessary medical equipment and respite care through the Part A home hospice benefit.
Eligibility
A physician must order your care for you to receive both home health and hospice services. Patients must need skilled nursing care or therapy, and the physician must also make a plan for your home treatment. To qualify for Medicare-covered home health services, you must be determined to be homebound, a situation where leaving your home is deemed a major undertaking. For entitlement to hospice care, your doctor must certify that your condition is terminal and that you're in the last six months of life, and you must personally sign a statement choosing hospice care over all other kinds of treatment. All hospice and home health services must be provided by agencies which are approved by the Centers for Medicare & Medicaid Services.
Ineligible Services
Medicare doesn't cover everything you might need for home health. As of 2010, Medicare won't pay for 24-hour home health services or any personal care given by nursing assistants -- if this is the only kind of care you need. In addition, Medicare won't pay for someone to provide housecleaning services like laundry, dusting or generally tiding, meals delivered to your house or shopping services.
Medicare Advantage
Medicare Advantage plans are required to offer the exact same benefits as original Medicare Parts A and B except for hospice care. If you receive your Part A benefits through a private Medicare Advantage plan rather than through the government, you might receive additional home health benefits. These private MA plans may have additional restrictions. If you have a Medicare Advantage plan or are thinking about enrolling in one, check your policy carefully to determine what home health benefits you're entitled to and what conditions your insurance company has stipulated to get them.
Tags: home health, hospice care, health benefits, health services, home health benefits, home health services
