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Senior Health Insurance: Health Cover for Medical Care at Home

Senior Health Insurance: Health Cover for Medical Care at Home

Introduction: Health Care at home for seniors is primarily important because it can be used to avoid Nursing Home or Hospital care.

Health Care at home is different from general care at home in the following aspects:

Health Care at home is done by trained medical individuals who are equipped to handle and understand the medical needs of seniors. These trained individuals are licensed professionals such as therapists, nurses and aides. After a patient’s physician directs a specific health care procedure, professionals who are perfect for the procedure, provide the recommended services.

On the other hand, general care services at home can be provided by unlicensed individuals who understand the general needs of the patient, which might also be non-medical in nature. Examples of some general care services at home are:

  • Medical Therapy
  • Rehabilitation
  • Recovering patient care
  • Mobility Assistance
  • Cooking and housekeeping for the patient
  • Medication assistance and monitoring

If we have gone through the above points we would find that both Health Care Services and General Care Services provide medical care at home.

However, the two most important reasons for selecting Health Care Services through a licensed Agency are:
  • INSURANCE COVERAGE: In order to avail due reimbursements from Medicare, it is important that we use the services of a licensed agency which provides Health Care at home.
  • AVAILABILITY: In case of general care services, individuals provide services, who at times due to emergency or any other reason might be absent from duty. Under such circumstances the patient might go without care for a considerable period of time.

However, we can still go for an individual service provider for our non-medical requirements, depending on certain factors like performance track record, experience and referrals.

Coverage on Expenses for Home Health Care Services:

There are quite a number of Insurance providers which offer plans for covering Health Care at home including MEDICARE and MEDICAID.

Criteria for each plan, is unique, however, medical necessity is the common factor in majority of plans.

It is important to mention in this case that there will be certain uncovered expenses that individuals need to pay themselves.

However, availability of agencies is also there who provide services to individuals of the low income group.

MEDICARE:

MEDICARE is one such provider which offers coverage towards Home Health Care. Though their requirements are stringent, yet many seniors fail to avail facilities, even though they are eligible, due to ignorance of the requirements.

This is primarily because many people have a strong misconception in regards to the meaning of the term “homebound patient “. We come across a lot of situations wherein patients leave home sporadically and still be eligible for health care at home.

One of the imperative aspects in this case is the opinion of a medical practitioner. Substantial amount of difficulty that the aged patient is facing to leave home should be mentioned clearly in the medical report that is generated.

Fulfillment of the following four conditions is very much required for MEDICARE:

  • A doctor is to decide on the requirement of medical assistance and care at home; he has to provide with a detailed plan for the care.
  • A patient should be in a situation, wherein he is under considerable difficulty in leaving home or unable to move out under normal circumstances.
  • The agency providing the services should be certified under the Medicare program.
  • At least one of the following services is required to be availed: Non-continual Nursing Services (skilled); continued occupational therapy; Speech- Language pathology services or physical therapy.

Nevertheless, it is always wise to consult a doctor for selecting a provider for health care coverage depending upon the specific medical needs. Opinion from Local reputed agencies can also be taken into consideration.

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