The Benefits of Medicare Coverage for Visiting Angels

1. Introduction

Medicare is providing health insurance for people who are aged 65 and above, under 65 with certain disabilities, and any age with end-stage renal disease (permanent kidney failure requiring dialysis or a kidney transplant). It is a valuable resource for senior citizens in the US. At some point, many Medicare recipients have considered whether or not their services would be covered by their Medicare benefits. In considering the immense value of their own health care in comparison to what Medicare offers, many have concerns that their services will, in fact, be insufficiently covered. And the good news is that Medicare will cover the home services provided by the healthcare professional for the patients who are considered “homebound”. Homebound means leaving your home isn’t a good choice for your health. (Ornstein et al.2020)(Cabin2021)(Harrison et al.2020)(Zimbroff et al.2021)(Oseroff et al.2023)

Visiting Angels is an organization providing home health care services for elderly adults. The kind of services provided by Visiting Angels are home care, elderly care, senior care, respite care, companion care, personal care, and also live-in care. The main aim of Visiting Angels is providing quality in-home care services for elderly adults so that they can age in place gracefully. Visiting Angels agencies are trained to provide these types of specialized services to our elderly clients.

1.1. Overview of Visiting Angels

Visiting Angels is an informal form of caregiving. It is America’s choice in home care. Specializing in elderly care, Visiting Angels provides a wide variety of services to make the elderly home experience more comfortable. More than a franchise, Visiting Angels has done its homework in the world of caregiving. Owned by individuals who have been caretakers of the elderly, Visiting Angels brings solid experience to the table. It is important to provide the best possible home care for your loved ones. At Visiting Angels, we are not about providing a caregiver for the elderly. We are about providing the best possible caregiver. This is why many Visiting Angels’ caregivers have previous experience in nursing homes or other forms of elderly care. With extensive backgrounds, our caregivers provide a wide range of services. This may include meal preparation, light housekeeping, companionship, and many other services. We make it our priority to provide a caregiver that will make the life of your loved one the best it can be. With life keeping us all busy, sometimes a little help can go a long way. Should it become too burdensome to run the kids to practice, shop for groceries, and prepare a daily meal, then Visiting Angels has a solution to help your loved one maintain a high level of independence. With a caregiver providing these services, family members can go back to being family participants. With a growing number of the “sandwich generation” who are taking care of their children as well as their parents, now has never been a better time to relieve the stress on one’s life. Finally, Visiting Angels provides a respite for family members. Should you need some time to travel, run errands, or just take a day for yourself, we can provide the needed care for your loved one. With caregivers skilled in many areas, family members can rest with ease knowing that their loved ones are being well taken care of. Now that you’ve learned a little about Visiting Angels, the next step is understanding how Medicare coverage can truly benefit the home care experience (simply). By obtaining a clearer understanding of home care coverage, and the beneficial results of care, a specific and significant choice to select home care as a wiser and more comforting alternative compared to other forms of care can be made available. (Riedman et al.2022)(Almevall et al.2022)(Allal-Chérif, 2022)(Frechman et al.2020)(Tănase et al.2022)(Almaghaslah et al.2021)

1.2. Importance of Medicare Coverage

According to a study conducted by the National Association of Home Care, “approximately 12 percent of Medicare beneficiaries receive non-Medicare home care” (The Basics of Medicare Coverage and The Impact of New Policies, 2000). Out of the 12 percent of those who have used home care, 52.8 percent reported that the care they received was paid for out of pocket and 29 percent used their own or a family member’s savings. This is an important finding, as the majority of individuals using home care services are doing so because they have health problems, are disabled, or are trying to maintain their current health condition (The Basics of Medicare Coverage and The Impact of New Policies, 2000). Medicare is an insurance program that is designed to offset the financial burdens of individuals who are disabled, 65 years of age or older, or those who are in end stage renal disease. With the majority of Visiting Angels clients being seniors and those who need assistance with activities of daily living, it is important to help these individuals and their families understand how Medicare can be used to fund home care services that will enable them to avoid the high costs of institutional care and maintain a higher quality of life. (Bressman et al.2021)(Kaufman et al.2023)(Schwartz et al.2021)(Fabius et al.2023)(Gangopadhyaya & Garrett2022)(Friedman, 2021)

As the population of the United States continues to age, it has become increasingly important to understand and take advantage of the many resources available to senior citizens. One of the most important and widely used financial resources for the elderly is Medicare. The Department of Health and Human Services finances Medicare, which is the country’s main public medical insurance program. It is available to anyone who is eligible for Social Security. Medicare provides various benefits for those who are eligible and the types of services covered by Medicare influence the use of other existing health policies. Therefore, it is essential to understand exactly what kind of services and which procedures are covered by Medicare. This is of importance to individuals, the Visiting Angels businesses who serve them, and their family members. Understanding Medicare coverage will help individuals make informed decisions when utilizing their Medicare benefits to access home care services. It will also be a helpful guide for the family members of those needing home care, as they may be assisting in the implementation of home care services.

2. Eligibility for Medicare Coverage

The Visiting Angels provide in-home health, personal care, and companionship to seniors. Certified nurse’s assistants are employees of an agency that will send assistance to a senior’s home. They are available to anyone in need of help and it is especially convenient for those with Medicare coverage because they are responsible for very little or no out-of-pocket expense. “The biggest benefit for seniors is that in 2000 Medicare, Medicaid, and other health insurance paid forty-five percent of all payments for home care services” (www.visitingangels.com). This takes a major burden off the shoulders of family members who are likely paying the remainder of the cost for health care services. This is great for the elderly and their families because they can spend little to no money for care and it allows the senior to maintain some independence. Medicare covers a portion of the Visiting Angels services and it is always beneficial to talk with a local agency and see if they provide services that are advantageous to the senior. (Silver & Hyman, 2020)(Moses, 2020)(Schaefer, 2021)(Friedman2021)(Mitra et al., 2022)(Prang et al., 2021)(Rauscher & Burns2023)(Miller et al.2022)

2.1. Age Requirements

Applicants must understand the guidelines for receiving coverage of services offered by Visiting Angels in order to make an informed decision about whether or not to apply for Medicare. The primary guideline is that the applicant must be enrolled in Medicare Part A or Part B and have a chronic health condition or a history of a health condition that requires skilled medical intervention. It is not mandatory for the applicant to have a chronic health condition, but it is necessary for one to exist in order to qualify for coverage. In any case, the applicant’s doctor must confirm that medical intervention is required and provide a plan of care with an estimated duration. Any service that requires coverage must have a reasonable expectation of improvement. The applicant’s doctor must confirm that the services required are expected to result in some improvement of the patient’s condition or prevent further deterioration. Medicare helps to cover the cost of many services which contribute to the accomplishment of such medical goals; therefore, it is often easy to meet this coverage requirement. An additional aspect of this guideline is that the services required must be considered safe, effective, and meet accepted medical standards. This means that experimental or unproven medical interventions are not covered by Medicare.

2.2. Medical Necessity

Medical necessity is defined as a required need for medical treatment which is above the ordinary care which can be given by a practical nurse. To meet medical necessity requirement, the patient must need skilled nursing care or skilled rehabilitation services. Patients who only require occupational therapy or physical therapy do not meet Medicare’s definition of covered treatment because these therapies are not skilled nursing or skilled rehabilitative services. Many patients and physicians falsely believe that an individual can receive long term care and medical supervision from a nurse to avoid hospitalization or to retard the progression of an illness or disability. This falls under maintenance therapy and do not qualify as a Medicare benefit. Due to recent lawsuits and change in Medicare contractors, it is becoming more difficult to receive treatment as proving medical necessity is hard to document and Medicare often denies payment stating treatment was not medically necessary.

2.3. Homebound Status

Being homebound means having an illness or injury that restricts the ability to leave home without the help of another person or the use of an assistive device (such as a walker, crutches, wheelchair, or scooter). If you have a condition (for example, a fear of leaving home after a traumatic experience) that makes you leave home only with considerable and taxing effort, you might also be considered homebound. Your doctor or other health care provider can help you determine if you’re homebound. Status is determined by your ability to leave home, and if doing so requires a considerable and taxing effort. It is not necessary to be bedridden. Largely, those who are more mobile and independent can still be considered homebound. Medicare recipients who are homebound and in need of skilled care are eligible to receive home health care services. The home health care benefit entitles you to skilled nursing care on an intermittent and part-time basis, physical therapy, speech-language pathology or a continued need for occupational therapy. In conjunction with skilled care, home health care providers also help patients with a prescribed home exercise program and daily activities. At Visiting Angels, seniors and adults can receive help with meal preparation, light housekeeping, and general companionship. Steps from the Physician: In order to receive home health care services, a patient’s regular doctor or specialist must determine that they have a medical condition that needs skilled care that can only be provided on an intermittent basis. If you are a Medicare recipient or eligible to receive Medicare, you have the option of changing doctors to one that is affiliated with a home health care agency. (Reckrey et al.2020)(Demiralp et al.2021)(Harrison et al.2020)(Simning et al.2020)(Reckrey et al.2020)(Burgdorf et al., 2020)(Falvey et al.2020)

3. Services Covered by Medicare

Budget projections for the home care services currently provided are significantly higher than the cost estimates of the Medicare home care benefit. This is particularly relevant for therapy services that currently use a prospective payment system. Due to this difference, there is great concern over whether patients will be able to easily obtain ordered services because many home care agencies are discontinuing or not providing a large volume of these services for Medicare patients based upon the low level of reimbursement. This issue and its potential effects on access to care for Medicare patients is a topic of current advocacy efforts for home care therapy.

In terms of information specific to our agency, it is important to add that in order to qualify for Medicare coverage for either skilled nursing care or therapy services, a patient must be under the care of a Visiting Nurse agency and must already be homebound. This means that the patient will not be able to leave home without a considerable and taxing effort and that absences from the home are infrequent, of short duration, or are for medical treatment. For therapy services, it is necessary for a doctor to sign a plan of care.

Covering services that are most relevant for the elderly utilizing the home care benefit, this section addresses personal care assistance, skilled nursing care, and therapy services. The goal of this section is to provide an understanding of what types of services Medicare will cover and how they are relevant to the elderly who are homebound and need nursing care. Medicare coverage information is based on national coverage determinations and may vary by location.

3.1. Personal Care Assistance

Incontinence is an issue that is embarrassing for many to discuss, yet it is a reality for a large number of elderly individuals. Guardians and their elderly loved ones should understand that incontinence is not a condition or a disease, but rather a symptom of something else going on in the body. Urinary incontinence can be caused by weak bladder muscles, as a side effect of certain medications, or even from a bad urinary tract infection. Fecal incontinence is sometimes a result of chronic constipation. No matter what the situation, the Visiting Angels’ compassionate caregivers will work to help maintain the elder’s sense of dignity and independence. A clean, positive, and reassuring environment can have a tremendous effect on incontinence. Oftentimes individuals need reminders to follow a toileting schedule, or assistance with hygiene after incontinence has occurred. Let Visiting Angels provide the caring assistance that will help your loved one to better manage this challenging issue.

It is not at all uncommon for elderly loved ones to have to deal with struggles in taking care of themselves. All too often, these elders will actually start to let their own personal hygiene go, as it is a task that becomes less and less worth doing in their own minds. Whether it is because certain hygiene and grooming activities have become difficult or uncomfortable, or because transportation and energy levels can no longer sustain “worthless” trips outside the home, the Visiting Angels Personal Care Assistance will afford the opportunity for your loved one to look and feel his or her best.

3.2. Skilled Nursing Care

Medicare will cover nursing care if it is ordered by a doctor and provided by a skilled nurse or therapist. This offers a chance for you to get short-term restorative care in a home setting. Home care helps you get better, regain your independence, and become as self-sufficient as possible. Plus, it is high-quality and generally less expensive than care in other settings. High quality is seen through lower hospital readmission rates in beneficiaries with chronic obstructive pulmonary disease, a hip fracture, or a stroke and have received home care by a Medicare-certified home health care agency. Higher rates of care satisfaction have also been apparent in home care patients. Paragraphs and bullet points are supported.

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3.3. Therapy Services

Physical or speech therapy is often necessary for the elderly to optimize health and independence. Whether it’s working one-on-one with a nurse for injury rehabilitation or having a therapist teach how to maintain quality of life and remain as independent as possible, Medicare coverage has these services covered. Visiting Angels has a network of therapists who will work with the elderly in their own home. Familiarity is very important for the elderly, and they will be more receptive to therapy from someone that they know. This can also serve as a great opportunity for the elderly to make a new friend and establish a relationship with someone new. In-home physical and occupational therapy can also make a big difference when it comes to maintaining independent living. Therapists from Visiting Angels work closely with the client, family members, and other medical professionals to develop a personalized plan. Step by step, they work to regain lost abilities and strengthen areas of weakness. This often includes safety-proofing the home and educating the client and family on how to prevent future injuries. During an illness, injury, or following a hospital stay, skilled care is often necessary. Medicare beneficiaries have coverage for Visiting Angels coordinated care provided by a registered nurse (RN) or licensed practical nurse (LPN). The main goal is to improve the patient’s condition and prevent hospitalization or readmission to the hospital or nursing home. This is a great option for those recently discharged from a hospital or rehabilitation center. Many illnesses and injuries require some type of skilled nursing care to make a full recovery, and the setting often determines the outcome. With familiar home surroundings and one-on-one attention, the client will be more likely to reach their highest level of functionality. Visiting Angels nurses will also work closely with the client’s other medical professionals to aid in the recovery process. (Hopwood & MacEachen2022)(Burch, 2021)(SORIANO)(Lawson et al.2022)

4. How to Access Medicare Coverage for Visiting Angels

4.1 Understanding Medicare Part A and Part B Medicare is a health insurance program for people age 65 or older, and for people under age 65 with certain disabilities. Part A of Medicare is hospital insurance and helps cover inpatient care in hospitals as well as skilled nursing facility, hospice, and home health care services. Part B is medical insurance and helps cover the cost of physician services and other medical services including both inpatient and outpatient services. In order to have home care services covered by Medicare, a person must have both Part A and Part B. It is most common that if a person does not have Part B, they can easily apply for it when they want home care services covered under Medicare. The premium for Part B is generally taken out of the beneficiary’s social security check. Part A and/or B also covers services that will help prevent your condition from getting worse or help maintain your current condition. This type of care is covered when a physician certifies a person’s need for these services based on a condition, usually done through an in-home assessment. This information is crucial because often times the nurse or agency providing the home care services will have to communicate the necessity of these services to maintain or prevent a condition from worsening to the physician who will then write an order for the services. In most cases, Visiting Angels agencies provide “private duty” or “custodial” care and these services are generally not covered by Medicare. However, if the physician certifies the necessity of skilled care services to maintain or prevent a condition from worsening, this type of service can be subcontracted to a home health care agency to provide.

Medicare coverage has the potential to greatly benefit seniors with limited financial resources. For seniors currently utilizing or considering the services of a Visiting Angels home care agency, there are several ways to access the Medicare home care benefit. This section outlines those methods and serves as a guide to seniors and their families through the process of obtaining Medicare coverage for home care services.

4.1. Understanding Medicare Part A and Part B

Assuming that the client’s medical needs are not urgent and they have time to arrange for services at home, Medicare will need to verify that the home care agency is certified to provide Medicare services. This can be confirmed by the home care agency voluntarily undergoing a rigorous survey process that examines all aspects of services to ensure that they meet health and safety standards. Upon acceptance of the survey and a determination of Medicare eligibility, the home care agency will then be permitted to provide Medicare services to clients.

The first step in accessing home care services through Medicare is obtaining a doctor’s order, which recommends assistance in the form of a skilled nurse or therapist to provide treatment at home. Since Visiting Angels are non-medical homecare providers, we do not need a recommendation on our own; however, the client must first be seen by a doctor who will need to write a medical order and make the decision as to whether a skilled nurse, therapist, or medical social worker is necessary.

Medicare is a two-part health care plan, whether provided by the government or a private insurance carrier. Medicare Part A covers medical treatment, whereas Medicare Part B covers doctor’s services. Medicare is the largest health insurance in the United States. In order to qualify for Visiting Angels services, a senior must be seeking coverage for both Medicare Part A and Medicare Part B.

4.2. Obtaining a Doctor’s Order

In order to obtain Medicare coverage to help pay for Visiting Angels homecare services, a doctor’s order is necessary as stated in §1861(r)(1) of the Social Security Act. Making an appointment for a consultation with a doctor is the first step in this process. The doctor must then confirm that the patient is unable to perform at least two ADLs (Activities of Daily Living) without assistance from another person. There are seven ADLs used to evaluate a patient’s level of needed care: bathing, dressing, transferring, using the toilet, eating, and walking. This can be done through a series of tests to eliminate a less severe or temporary diagnosis. The doctor must also confirm that professional care is needed for safety reasons and/or if the patient has a complex medical condition. The next step is to determine if the patient needs skilled care or home health care as defined in §1861(m) of the Social Security Act. Significantly more restriction to qualify for this type of care makes it a poor workaround strategy that an Angel’s client would likely not benefit from. Confirm with the doctor that the prescribed care is Custodial care as described in the National Coverage Determinations (NCD) Manual 240.2. A doctor’s order for homecare services from Visiting Angels will not meet the qualifiers if it repeals a denied necessity for skilled care services.

4.3. Working with Visiting Angels and Medicare

The final way to obtain Medicare coverage for the services provided by Visiting Angels is choosing a home health agency that participates in the Medicare program. At Visiting Angels, we do accept Medicare assignment, meaning that we will bill Medicare directly for the covered medical services that are performed by our home health aides. The patient will not need to pay us for these services, rather we will bill them to Medicare. Medicare will pay the agency directly for these services and the cost will be taken out of the home health benefit. So long as the patient continues to meet the qualifications for the home health benefit, the cost of the services provided by Visiting Angels should be covered in full, depending on the case, for the patient. This can be reassured by requesting home health services from your doctor as he will always refer you to a participating Medicare agency knowing that Medicare will be billed and the costs will be covered from your home health benefit. Medicare is a great option for those who are in need of personal home care and companion services. For those who meet the coverage standards, the services can essentially be obtained at no cost to the patient and Visiting Angels is there to assist you in the steps and to make sure that our services are affordable and beneficial for you.

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