Getting coverage for your HHA or in home care isn’t as complex as it might seem at first. These are the requirements for being eligible to receive coverage in home care: you are homebound, you have a medical necessity, and you have access to a certified HHA agency. So what is being homebound? Being home bound according to medicare.gov is having trouble leaving the home without help because of an illness or injury. If you require a cane, wheelchair, walker, crutches, special transportation, or help from another person you could be eligible. If leaving your home isn’t recommended because of your condition and if you’re normally unable to leave your home because it’s a major effort. (Home Health Service, Medicare)
The list of covered home health services include :
- Wound care for pressure sores or a surgical wound
- Patient and caregiver education
- Intravenous or nutrition therapy
- Injections
- Monitoring serious illness and unstable health status
- Physical therapy
- Occupational therapy
- Speech language pathology service
- Medical supplies for use at home
- Disposable negative pressure wound therapy devices
- Part-time or intermittent home health aide care like(Only when also receiving skilled nursing care, physical therapy, speech-language pathology services, or occupational therapy at that same time):
- Help with walking
- Bathing or grooming
- Changing bed linens
- Feeding
- Note: Only if you’re also getting skilled nursing care, physical therapy, speech-language pathology services, or occupational therapy at the same time)
- Injectable osteoporosis drugs for women
- Durable medical equipment
- Medical supplies for use at home
- Disposable negative pressure wound therapy devices
(Home Health Service, Medicare)
The requirements for Medicare coverage also include a face to face with a doctor or nurse practitioner to assess your needs. After you receive permission to receive care from an agency you can begin your search for a certified Home Health Agency. There are many HHA agencies that advertise care on the internet and listings are available through your doctor.
There are some things that Medicare doesn’t cover like 24 hour care. Instead, .you could be covered for up to 8 hours a day with a maximum of 35 hours per week. Medicare also doesn’t cover the home meal delivery and homemaker services like shopping and cleaning. Personal care services like bathing, dressing, or using the bathroom aren't covered by Medicare either. That is when those are your needs without any medical diagnosis that can be verified by a medical professional.
In Ohio Home Health Aide Agencies are required to complete pre-claim paperwork with the department of Medicare. Pre-claim paperwork helps to determine eligibility for in home care coverage. Ohio is not the only state to have this process in place: Florida, Illinois, North Carolina and Texas also have a pre-claim procedure in place. Once approved you can begin working with a HHA of your choice. There are other options like personalized out of pocket care starting at 20.00 dollars per hour. Personalized out of pocket care can be tailored to your specific needs and schedule. Unlike Medicare, HHA coverage out of pocket care includes all personal care like meal prep, cooking, shopping, errands, cleaning, bathing, dressing, bathroom assistance without the need for medical approval. Out of pocket care includes any routine and schedule like 24-hour care. At Champion Care we have a single form to help understand your needs and care plan. This information is then used to help prep the caregiver arriving at your home as soon as that week. Electronic payment methods eliminate all billing paperwork and the hassle of paying your weekly caregiver bill. To learn more about how Champion Care can help with your non medical caregiver coverage click on this link.
Citations:
“Home Health Services.” Medicare, www.medicare.gov/coverage/home-health-services. Accessed 7 Oct. 2024.