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While obtaining quality care might be among your biggest priorities, sometimes you may need extra assistance to ensure your well-being, or the well-being of your loved ones. As a trusted network of home health care agencies, Visiting Angels is a franchise agency offering a range of tailored in-home care services.
Understanding Medicare coverage options for in-home care is essential for making informed decisions. In this article, we will navigate the nuances of Medicare coverage and distinguish between skilled and non-skilled in-home care. We will also provide real-life examples and offer valuable tips for financing in-home care services.
Understanding Medicare Coverage for In-Home Care
Medicare is a federal health insurance program for individuals aged 65 and older, and those with end-stage renal disease or certain disabilities.
Although it does provide coverage for certain home health services, knowing the difference between skilled and non-skilled is fundamental to determining the extent of Medicare coverage available.
Skilled care involves services provided by medical professionals. It includes services such as skilled nursing care, physical therapy, speech-language pathology services, and occupational services. Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) cover these skilled services subject to certain conditions.
Non-skilled care, on the other hand, encompasses personal care services like bathing, dressing, and other daily activities. Medicare generally does not cover non-skilled care.
Visiting Angels and Medicare Coverage
Visiting Angels offers a wide range of in-home care services to support individuals in their day-to-day lives. Their services may be eligible for Medicare coverage only under specific circumstances though.
Several factors come into play in determining Medicare coverage eligibility for services provided by Visiting Angels.
- The individual must have had a hospital stay of at least three days. This is a qualifying event that opens the door to Medicare coverage for subsequent care services.
- The Individual must enter into Medicare-approved care within 30 days of their hospital stay. This ensures a smooth transition from hospital care to in-home care under Medicare coverage.
- A doctor’s certificate is necessary to establish the need for skilled care services such as physical therapy, skilled nursing care, or other skilled services. The doctor’s certification is a critical step in confirming the medical necessity of the skilled care provided by Visiting Angels.
If these criteria are met, Medicare will cover skilled-care services offered by Visiting Angels.
This coverage includes 100% of the care for the first 20 days. From day 21 to day 100, Medicare covers a portion of the total amount while the patient is responsible for a daily coinsurance. Medicare coverage for skilled care services provided by Visiting Angels ceases after 100 days and the individual becomes responsible for the entire expense.
Case Studies and Examples
Let’s consider two scenarios that highlight the coverage options for skilled and non-skilled care by Visiting Angels.
Sarah’s Situation: Medicare Coverage for Skilled Care by Visiting Angels
Sarah, a Medicare beneficiary, requires skilled nursing care and physical therapy due to a recent hospital stay. Visiting Angels provides the necessary skilled services to aid in her recovery process. Medicare Part A and Part B may cover the skilled care services provided by Visiting Angels if it meets the following criteria:
- Sarah had a hospital stay of at least three days.
- She entered into Medicare-approved care within 30 days of her hospital stay.
- A doctor has certified the need for skilled care, such as physical therapy or skilled nursing.
Under these circumstances, Medicare will cover 100% of the cost of care for the first 20 days and a portion of the total amount from day 21 to day 100. She will be responsible for all expenses after 100 days.
Mark’s Situation: Medicare Limitations for Non-Skilled Care by Visiting Angels
Mark requires assistance with personal care tasks like bathing, dressing, and meal preparation, which fall under non-skilled care services. Unfortunately, Medicare does not typically cover non-skilled care provided by Visiting Angels.
However, there are alternative payment options to consider for non-skilled care services. Mark can explore options such as: paying out-of-pocket, long-term care insurance, or local community resources. More information on these options is outlined below.
While Medicare may not cover non-skilled care, exploring these alternate payment options can provide Mark with potential avenues to secure the necessary care services from Visiting Angels. In the next section, we will delve further into tips for financing in-home care services, which will provide additional insights and options for Mark to consider.
Tips for Financing In-Home Care Services
While there is limited Medicare coverage for Visiting Angels’ non-skilled care services, there are other avenues to explore for financing in-home care services:
- Medicaid and other state programs: Medicaid is a state and federally-funded program that offers assistance with medical and long-term care costs for individuals with limited financial resources. Medicaid programs vary by state, but several states provide coverage for personal care services similar to those offered by Visiting Angels. Eligibility requirements and covered services can differ, so it’s essential to research the specific Medicaid program in your state to determine if you qualify for coverage.
- Long-term care insurance: These policies cover the costs associated with long-term care services, including non-skilled care provided by agencies like Visiting Angels. If you have a long-term care insurance policy, review the policy terms and coverage details to understand what services it covers and if there are any waiting periods or associated costs.
- Local community resources and non-profit organizations: Many communities have local resources and non-profit organizations that offer assistance with non-skilled care services. These organizations may provide financial aid, grants, or other programs to help individuals access the care they need. Researching local community resources and reaching out to non-profit organizations can provide valuable information and potential financial support options.
- Private pay: For individuals who do not qualify for Medicaid and don’t have long-term care insurance, private pay options are available. Private pay means paying for non-skilled care services out of pocket. The cost of care can vary based on factors such as the level of care needed, the number of hours of service required, and the geographic location. It’s advisable to discuss rates and payment arrangements with Visiting Angels or the chosen care provider.
When it comes to understanding your Medicare coverage for Visiting Angels services, it’s important to make well-informed decisions. At CoverRight, we provide you with the knowledge and support you need to navigate the complexities of Medicare and make the best choices for your in-home care needs.
Contact us today to receive personalized guidance and concierge-level services with any aspect of Medicare.
Frequently Asked Questions
Q. How can I determine if I qualify for skilled care services covered by Medicare?
To qualify for skilled care services covered by Medicare, you must have had a recent hospital stay of at least three days, entered into Medicare-approved care within 30 days of the hospital stay, and have a doctor certify the need for skilled care.
Q. Are there any specific medical conditions or criteria that Medicare considers for coverage of in-home care?
Medicare covers in-home care services for individuals who are homebound, under a doctor’s care, and require skilled care such as physical therapy, skilled nursing care, or other skilled services. A doctor must certify the medical condition and the need for skilled care.
Q. What if I need a combination of skilled and non-skilled care services?
If you require both skilled and non-skilled care services, Medicare will cover the skilled care that meets the qualifying criteria. Healthcare professionals provide skilled care services and require specialized expertise. However, Medicare generally does not cover non-skilled care, which includes tasks like bathing and meal preparation.
To address your non-skilled care needs, explore alternative payment options such as long-term care insurance, Medicaid programs, or private pay options. Additionally, community resources and non-profit organizations may offer assistance. Consulting with a healthcare professional or Medicare specialist can help you navigate these options and create a comprehensive care plan that meets your specific needs.
