Having home health care products in your home can help you and your family in many ways. Some benefits include keeping you safe in your own home, providing you with the comfort and support you need, and helping you live the best life possible.
Covered by Medicare
Unlike Medicaid, Medicare does not cover most medical equipment and supplies used at home. Instead, it pays for 80% of the cost of medically necessary durable medical equipment.
This includes oxygen, wheelchairs, walkers, and blood sugar meters. The Medicare Part B deductible applies. In addition, beneficiaries must pay a 20% coinsurance on the allowed purchase price. If they have supplemental insurance, it will pay the remainder.
A physician or other health care provider must prescribe durable medical equipment. Equipment must be medically necessary and be purchased from a Medicare-approved supplier.
Medicare does not cover 24-hour care, meal delivery, or household help. However, some services, such as home health aide services, physical therapy, and speech-language pathology services, are covered. A Medicare-certified home health agency provides these services.
Home health care aide services are covered on an intermittent basis. Intermittent care is defined as less than eight hours per day for up to 21 days.
Costs may be different for beneficiaries enrolled in Medicare Advantage plans.
Those enrollees in Medicare Advantage plans will have different costs than those in traditional Medicare, especially in Part D. Medicare Advantage Part D costs will vary due to the plan’s costs, benefits, and pricing tiers. Some Medicare Advantage plans may offer extra benefits not provided in traditional Medicare. Those plans may also require enrollees to use particular drugs or medications.
Some Medicare Advantage plans will cover hearing and vision services. Some plans will also offer transportation to doctor’s visits and fitness programs. Those enrollees may also have to pay coinsurance or copayments. The cost of care will also vary depending on the plan’s network.
Most Medicare Advantage enrollees are in HMOs, but some plans specialize in care for chronic conditions. These plans have lower medical loss ratios. These lower costs suggest higher profits for the insurers.
Medicare Advantage plans also have a cap on out-of-pocket expenses. The out-of-pocket cap for Part A and Part B services is $8300 annually. If costs go above this cap, enrollees may have to pay additional premiums.
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