Things to Consider When Integrating Your Home Health Care With Medicare

Medicare can be confusing, all the more so when you combine that complex health issues and the need for medical assistance such as oxygen or hospital beds. While the insurance maze can be difficult to traverse, an estimated 47.5 million people receiving Medicare in 2010, more than one-sixth of the nationâ € ™ s population.

Here is a brief overview of Medicare and some answers to some frequently asked questions about Medicare and health care at home.

1. Who is eligible for Medicare?

Medicare is a national health insurance program provided by the U.S. government for those who:

- 65 and older

- Under 65 with certain disabilities

- Diagnosed with End Stage Renal Disease (ESRD), a form of permanent kidney failure requiring dialysis or a kidney transplant

2. What kind of services does Medicare cover?

Medicare has four different sections of coverage: Part A, B, C, and D. Medicareâ ŒOriginal â € €? consists of Part A and B, while Part C is known as â € œMedicare advantage Plana €??. The fourth section briefly summarized:

- Medicare Part A: Hospital Insurance

o Part A covers hospital care for as well as health care in skilled nursing facilities, home health care, and hospitals.

- Medicare Part B: Medical Insurance

o Part B covers Doctora € ™ s visits as well as visits to other health care providers. In addition, Part B covers outpatient hospital, durable medical equipment (such as intravenous infusion devices), and home health services. Part B also covers certain types of preventive services, such as getting a certain vaccinations.

- Medicare Part C: Medicare Advantage

o Part C combines your choice of health plans purchased from other private insurance companies approved by Medicare. Part C also integrate Medicare prescription drug coverage (Part D) and can be customized to include additional benefits for an additional fee.

- Medicare Part D: Medicare Prescription Drug Coverage

o Part D covers prescription Medicare-approved prescription drugs and other medications can lower costs. Similar to Part C, the Medicare-approved private insurance companies also run Part D.

3. Why do I have to choose between Medicare plan?

Options â € ŒOriginal Medicareâ €? (Part A & B) requires payment of a monthly premium for Part B and may require additional protection to pay deductibles and coinsurance to see doctors, hospitals, and other providers who accept Medicare. If you need prescription drug coverage, you must pay a monthly premium to join a Medicare Prescription Drug Plan (Part D).

 € œMedicare advantage plana €? (Part C, which includes Part A & B), also requires payment of a monthly premium in addition to the Part B premium and a copayment in-plan physicians, hospitals. If prescription drugs are not covered by your supplemental coverage, you have the option to join a Medicare Prescription Drug Plan (Part D).

As with prescription drugs, you can buy additional coverage to cover services not covered by Medicare. Medicareâ ŒOriginal € Â €? Plan allows for the option to purchase Medicare Supplement Insurance (Medigap), while â € œMedicare advantage Plana €? does not.

It is wise to always check whether you can take advantage of additional coverage through an employer or union, military, or Veteranâ € ™ s benefits.

4. Is home health care is covered by Medicare?

Medicare website states, â € œMedicare only covers home health care on a limited basis as instructed by your Doctora €??. As discussed earlier, Part A & B is a choice that Medicare covers home health care services is determined by Medicare.

Home health care coverage by Medicare in New Mexico set you must meet the following criteria:

- You are receiving regular services of a doctor. This physician also must maintain a unique treatment plan for you, which is reviewed periodically.

- Your doctor should declare œneedâ â € €? for certain medical services such as the requirement for intravenous drug therapy, physical therapy, occupational therapy, respiratory therapy, or speech-language pathology services.

- Home health agencies provide services you have Medicare certified (for more details see below).

- Your doctor must declare your health status as the elderly, which is shown by the following:

o Your health limits you leave the house.

o You can travel from home without assistance (eg transportation assistance such as tools or people).

o Leaving your home requires considerable effort and can damage your health condition.

5. My company does not take Medicare home health, why is this?

Medicare-approval process is lengthy and expensive, so while it may seem that many companies can not take Medicare, they may actually be in the process of becoming Medicare certified.

Furthermore, the criteria for Medicare eligible individuals to receive health care at home is very tight, the reality is that a lot of people who may apply for Medicare coverage for services they approved home health companies will not actually receive coverage. Currently, Medicare pays only about half of all health care costs for the elderly. Medicare denies payment because very often do not meet the criteria, so it is important to be aware of if you meet these criteria before you limit yourself exclusively to the Medicare home health care company-approved.

It is important not to be overwhelmed by the complexity of Medicare, because there is a great wealth of information on the Internet. When researching Medicare, your first stop should include the official U.S. government site for Medicare, http://www.medicare.gov.

For large graphs, and more information about your Medicare options, see http://www.medicare.gov/navigation/medicare-basics/coverage-choices.aspx

To find if Medicare covers medical services or tests, see http://www.medicare.gov/Coverage/Home.asp

To find out more about 2012 Medicare costs in http://www.medicare.gov/cost/

In conclusion, it should be realized that while Medicare covers home health only to stay at home, home health care is NOT exclusive to reside in the house. Home health care agencies offer a variety of services that not only benefit people who are not covered by Medicare, but also those who stay at home or vice versa.