Understanding Medicare FAQs

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What is Home Healthcare?

Home healthcare, also known as home care and home support services, or DME highlights a wide range of medical and non-medical services delivered in an individual's home. The spectrum of services ranges from high-tech infusion nursing to non-medical home care services. Health care delivered in the comfort and security of the patient's home provides him/her and the family a sense of control and peace of mind. Home care also helps reduce the stress caused by extreme hospital or nursing home bills during an illness or disability. Staying at home will allow the patient to maintain social ties and involvement with the community, friends and family. This illuminates a sense of independence and security for the patient.

Who is Eligible for Medicare Home Healthcare?

To be eligible for Medicare covered home health care, you must meet the following criteria:

  • You must be under a physician's care and the physician must order the services.
  • You must require a skilled, intermittent service such as: skilled nursing care, physical therapy, or speech therapy.
  • You must be homebound due to an illness or injury which makes it hard for you to leave home in order to receive medical care.

What is Homebound?

Medicare considers a patient to be homebound if “leaving the home would require a considerable and taxing effort," and if “he/she has a condition due to an illness or injury which restricts his/her ability to leave his/her place residence except with the aid of supportive devices such as crutches, canes, wheel chairs and walkers, [with] the use of special transportation, or the assistance of another person, or if leaving the home is medically contraindicated." Homebound patients may leave home “if the absences are undertaken on an infrequent basis or are relatively short duration or for the purpose of receiving medical treatment."

Is Medicare only for the elderly?

NO? You may download a copy of the brochure published by the government that offers more details regarding Medicare and Medicaid coverage for Home Health Services.

Is Durable Medical Equipment provided?

Yes. Arrangements for these services will be made for the special needs of the patient and in most cases are covered by Medicare. Examples include: commodes, wheelchairs, crutches, hospital beds and I.V. equipment.

How long does the service last?

What's called an “episode" refers to a 60-day-service duration; however, it does not mean that it's the standard or average. Ongoing evaluations by the assigned nurse and your doctor throughout the plan of care will determine the length of service appropriate for each individual patient.

What is Durable Medical Equipment?

Durable Medical Equipment (DME) is equipment that withstands repeated use and is utilized primarily to serve a definite medical purpose.

Does DME Need to Be Prior Authorized?

Some items require prior authorization by the supplies