Social Security & Medicare Questions: September 2011

Social Security & Medicare Questions: September 2011

Q: My husband is 86, has heart problems, a chronic eye condition, and is beginning to have symptoms of Alzheimer’s. What types of home care will Medicare pay for?

A: Your husband must first qualify for the home health benefit, and the coverage provided by Medicare, which is limited. If he qualifies, Medicare Part B covers medically - necessary part-time skilled nursing care and home health services up to seven days a week, for no more than eight hours per day and 28 hours per week.

To qualify, his doctor must order the care, and the care must be provided by a Medicare-certified home health agency. He must be “homebound,” meaning that he cannot leave home without a major effort. The following is a list of the services (and limits):

• Skilled nursing care: Medicare pays in full for skilled nursing care that can only be performed by a licensed nurse, such as injections and teaching patients to self-inject, tube feedings, catheter changes, and wound care.

• Skilled home health aide: Medicare pays in full for a home health aide if skilled services are required. These can include help with bathing, using the toilet and dressing. If your husband requires personal care alone, he does NOT qualify for the Medicare home health benefit.

• Skilled therapy services: Physical, speech and occupational therapy services that can only be performed by the licensed therapist and that are reasonable and necessary are covered.

• Durable medical equipment: Medicare pays 80% of the Medicare - approved amount of items like oxygen equipment and supplies, wheelchairs, walkers and hospital beds ordered by a doctor for use in the home. Some items must be rented. Caution! You must get your covered equipment and supplies from a Medicare-approved supplier for Medicare to pay. In certain areas of the country you need to use specific suppliers in order for Medicare to pay for certain items. For a list of Medicare-approved suppliers, visit or call 1-800-MEDICARE (1-800-633-4227).

What you can do: To learn more, download copy of Medicare & You 2011 or call 1-800-MEDICARE (1-800-633-4227) and request a copy.

Additional resources on the web: Find answers to your Medicare questions at Medicare Interactive, Medicare Rights Center.