Dennis W. Fox & Associates

 " Representing individuals before the Social Security Administration." Call 314-241-9666

 SERVICES AND CARE

Home Health Care
If you have Medicare part a hospital insurance, it will cover the cost of many home health care services. This might include occupational therapy, physical therapy, home health aides, and medical social services. In order for Medicare to pay the full approved cost of these home health visits, you must be confined at home, and meet certain other conditions. Also, the services must be provided by a home health agency that participates in Medicare. There is no limit on the number of visits you may receive. Part-time or intermittent services are covered as well. Medicare medical insurance will pay for some home medical equipment, such as wheelchairs, hospital beds, and oxygen. However, you will be responsible for a 20% co-payment. Not all home equipment is covered: among other things, it must be durable, medically necessary, ordered by a doctor, and not be helpful to people who are not sick or injured.

For more specific details about Medicare home health coverage, deductible amounts and other figures, contact the social security office.

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Hospice Care
Hospice care is another of the services covered by Medicare part a hospital insurance. A hospice is a medical facility that cares for terminally ill patients, offering pain relief and other support services. Typically, the atmosphere is more home-like than the average hospital. Medicare will help cover the cost when a person is terminally ill, assuming the hospice is Medicare-certified, and meets certain conditions. However, there are special benefit periods for hospice care.
Medicare allows a maximum of two 90-day periods of hospice care, one 30-day period, and one extension period of indefinite length. It's important to note that hospice care is not the same as custodial care. Custodial care is defined as care that could be safely given by a person who is not medically skilled; most nursing homes fall under this category. If you or a loved one has a terminal illness, check with the social security office, for more details on hospice care. They can help you verify if a facility is approved, and explain how your Medicare benefits apply.

Call social security toll-free, at 1-800-772-1213.

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In-Patient Hospital
Medicare part a helps pay for up to 90 days of in-patient care per benefit period, in any Medicare-participating hospital. During the first 60 days, you pay a deductible amount, then Medicare pays for all other covered services. During days 61 through 90, you are responsible for a daily co-insurance amount, and Medicare pays the remaining cost of all covered services. Co-insurance is the part of the bill that a beneficiary must pay, even after the deductible is met. Once you are out of the hospital for at least 60 consecutive days, a new benefit period may begin. If you have to go back in the hospital, you have another 90 days of coverage, but must pay another deductible. Those who require more than 90 days of care during a benefit period may be able to use their reserve days. Every beneficiary gets 60 reserve days in their lifetime; you can use them at any time to extend coverage of a hospital stay. On a reserve day, as on a regular benefit day, you pay the daily co-insurance, and Medicare pays for the remainder of covered services.

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Skilled Nursing Facility
Skilled nursing is care given by medically-trained personnel, following a hospital stay; it is not the same as custodial care commonly given in nursing homes, such as help with walking, dressing, or eating. Medicare does not cover the cost of custodial care, when that is the only type of care you need. But if you require skilled nursing or rehabilitation services after you get out of the hospital, medicare pays for up to 100 days in each benefit period, if the facility is medicare-approved. You may need to meet certain other conditions; a social security representative can give you more details. Typically, in the first 20 days, hospital insurance pays for all covered services. Then, during the next 80 days, you pay a daily coinsurance amount, and medicare pays the rest of covered services. To find out more about how medicare hospital insurance can help with the cost of skilled nursing and rehab facilities, contact the social security office.

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