FAQs regarding Home Health
Who qualifies for Medicare coverage?
To qualify for Medicare coverage:
- The patient must be 65 years old or older.
- The patient currently receives Social Security benefits or is enrolled in the railroad retirement system.
- The patient is younger than 65 years old and has received Social Security disability benefits for at least two years (24 months).
- The patient suffers from permanent kidney failure.
If the patient is 65 or older and still working, will Medicare pay for home health service?
Yes, a patient can use Medicare. However, if a patient is covered by an employer’s insurance plan, the employer’s health insurance could be used in conjunction with Medicare.
Are home visits covered under Medicare?
Yes, if each of the following conditions is met:
- The patient’s physician has requested home healthcare and established a plan of care.
- The agency is Medicare-certified.
- The patient cannot leave home without assistance.
- The patient requires nursing care, physical therapy or speech therapy that is reasonable and necessary throughout the patient’s episode of care.
Do patients have to pay Alacare for visits?
No. Alacare will bill Medicare directly. Medicare has two parts:
- Part A – hospital insurance that is part of the patient’s Social Security benefit
- Part B – medical insurance the patient pays for monthly
Do patients decide whether to use Part A or Part B of Medicare?
No. Part A and Part B will pay for covered home healthcare services. Alacare will inform the patients of their coverage.
Does Medicare cover outpatient physical therapy?
Yes, if the physician refers the patient and the patient qualifies for outpatient therapy.
Are services for mental illness covered?
Yes, if the patient qualifies for home healthcare under Medicare.
FAQs regarding Hospice
What is hospice?
Hospice offers palliative care that seeks to comfort rather than cure. Hospice offers comprehensive, compassionate care for people at the end of life and support for their families.
Does Medicare pay for hospice services?
Yes, if the patient qualifies for hospice services.
Who can receive hospice?
Any person facing the advancing stages of any terminal illness is eligible for palliative care. Hospice care is appropriate when the following conditions are met:
- The physician thinks that the patient will live six months or less if the disease runs its normal course
- Aggressive treatments are not working or providing relief to the patient
- The patient, family and physician agree and understand that the focus of hospice care is on comfort (pain control and symptom management), not cure
All U.S. citizens age 65 and older are entitled to Medicare coverage for hospice at the end of life.
Where is hospice care provided?
Hospice is a philosophy of care, not a place. Most hospice patients receive care in their home or the home of a relative or friend. Palliative care can also be provided in many long-term care facilities, assisted living facilities, hospitals or nursing homes. Some hospices have residential units designed to provide a homelike setting where hospice is provided.
How is hospice care different from other types of home health care?
- Comfort vs. cure: For most home health care providers, the goal is to get the patient well. In hospice, the staff and family recognize that the patient will not get well. They focus on comfort and support, rather than cure.
- Interdisciplinary team approach: All members of the care team – the physicians, nurses, social workers, grief support and spiritual care counselors, aides and volunteers – work together to coordinate care.
- Family focus: Alacare’s palliative care focuses on the entire family. The hospice team teaches the family how to be involved in their loved one’s care.
- Grief support: Hospice care does not end when a patient dies. Alacare’s grief support staff and volunteers maintain contact with the family for up to13 months after the death of a patient.
Who pays for hospice?
Hospice care is covered by most insurers, including Medicare, Medicaid, Blue Cross/Blue Shield and most private insurers and HMOs. Hospice is a covered benefit under Medicare for people who have a life expectancy of six months or less. Most policies cover all costs of hospice care, though some may require a copay for prescriptions.
When is hospice appropriate?
Palliative care becomes appropriate when treatments are no longer effective and the burden of the disease becomes too much to bear for the patient and family. Alacare’s goal is to provide relief from physical and emotional pain so that the patient and family can spend their remaining days with comfort and dignity.
What if the patient gets better?
If the patient’s condition improves, he or she can be discharged from hospice and return to aggressive treatment or resume daily life. If the patient should later need to return to hospice care, Medicare and most insurance programs will allow additional coverage.
What if my doctor does not mention hospice?
The patient and family should feel free to discuss hospice care at any time with their physician, other health care professionals, clergy or friends. Everyone is urged to prepare Advance Directives that spell out the type of care we want to receive at the end of life.
Who can refer a patient to a hospice program?
Anyone can refer a patient to a hospice program. To be admitted, a patient must:
- Agree to treatment aimed at comfort rather than cure
- Have an incurable disease resulting in a limited life expectancy, as certified by a physician
What does the hospice admission process involve?
When a patient is referred to Alacare, the office will call the patient’s physician to make sure he or she agrees that hospice care is appropriate for this patient. The patient will be asked to sign a consent form confirming that he or she understands that hospice care is palliative (aimed at comfort and pain relief) rather than curative.
Contact us if you have any questions.