Medicare Facts Everyone Should Know, But Too Few Do

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posted by Ted Ryan on September 18, 2013

When speaking with individuals inquiring about home care services, the topic of Medicare comes up often. It can be a misleading subject because though Medicare does cover some home health care services, they must meet very specific criteria. For this reason, Medicare enrollees may find themselves paying for services out of their own pocket.

Agencies like Seniors Home Care fall under the category of long-term care, and are not covered by Medicare. These agencies provide assistance with routine activities for individuals with ongoing functional limitations.

Services covered by Medicare involve the medically-related skilled nursing and therapy required after hospital or outpatient treatment. Eligible cases require:

  • Doctor certification of need
  • Service based on a plan of care established and regularly reviewed by your doctor
  • Doctor certification of being homebound
  • A Medicare-certified agency – a growingly difficult feat since Missouri stopped offering such certification. For a non-certified agency to become certified, they must buy a company that is.

It’s important to understand the limits of Medicare coverage when making long-term care decisions. Most Medicare enrollees, like most Americans, have no insurance protection for long term care. Avoid surprises by asking about coverage before starting services with an agency.

It has been our experience that many individuals who have coverage through Medicare also need non-medical services provided by companies such as Seniors Home Care. We are happy to offer advice, make recommendations and serve as your St. Louis community resource. If you have questions, please let us know.

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