The Medicare Maze

the buck (may) stop here.

Medicare - In these uncertain times during Obama's Health Care Reform, who knows if it will be around tomorrow and how much it will pay. At any rate, it pays for most of home health care services to 65+ year olds and qualifying individuals... BUT, as a patient, you have a part to play too. Medicare requires certain conditions to exist before paying the bill. Besides patient responsibilities, you must be compliant with your plan of care, be considered homebound, require skilled services and show progress towards goals.

This popular insurance tends to pay for acute medical conditions assuming that the beneficiary will rehab from this condition. This would account for most hospital stays (part A) and some nursing home (part A) time and most home health care (part A). It usually does not cover assisted living and 'thinks twice' about covering chronic illnesses or disabilities

Part B usually carries a premium cost and helps to pay non hospital medical care such as physical therapy, occupational therapy, doctors, outpatient medical services

Part C and D also come with a premium, have additional services such as vision and dental and prescription drug coverage.

The history of this widely used and now, widely abused health care goes back many many years and has evolved over time much like everything else has - into a lot of corruption.

These pages are not the final say as home health care is so unique to each individual situation. Submit your questions on our "Do I Need Home Health Care?" forum for answers to your unique, individual situation. Some choose a lifestyle that will help them avoid home health care in the future.

At times, patients may be somewhat thrown into home health care against their wishes for whatever reason. They may not want home care but need it. They may not need home health and are in sound mind to refuse it.

Sometimes a simple stumble over the dog can be blown into a full blown perceived need for home health care when balance is not an issue, sometimes dogs just get in the way. Whatever your reason, as the patient, you still have patient rights including the right to refuse home health care, (with a gentle explanation of potential consequences).

Medicare is a great net allowing millions of American's to age in their homes and become independent after various health impairments, however, just like any other insurance payer source, your care can be affected by it.

Some home health agency's who bill Medicare for your services are blatently dishonest, some commit Medicare fraud unknowningly. We do our best to promote only those home health agency's who have shown consistant, yearly training to their employees denouncing and prohibiting fraud in any way, shape or form. Sometimes, though, questions arise - by helping you understand what to expect from your home care team and when to question, you can help keep these highly respected agency's honest and commendable.

And, in defense of home health care agency's there are many patients/caregivers out there who will play the system and seek to obtain home health care when they don't require a skilled service. Some are lonely and enjoy the 'visitors.' Others are looking for home health aid services (which are not paid for except when nursing, physical therapy or occupational therapy is required) and will present with all kinds of ailments to obtain this "free" home maker service. Some, unfortunately, lie about their homebound status - only to be discovered and discharged. The list goes on an on...and so does the fraud. Will you be a part of the crime or a part of preventing it?

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RELATED PAGES:

Discover how to Prevent Home Health Care the Wise Way!

How does a home care agency get paid?

Medicare may not pay if you are not homebound

What are my patient rights and patient responsibilities?

Senior Health Care Insurance Options For Home Care

How does a Physical Therapist Pay Structure Affect My Quality of Care?

Do I Need Home Health Care?

Brag About Your Agency!

Thank Your PT!