By David Sayen, Medicare Regional Administrator

Medicare covers a variety of heath care services that you can receive in the comfort and privacy of your home. These include intermittent skilled nursing care, physical therapy, speech-language pathology services, and occupational therapy.

Such services used to be available only at a hospital or doctor’s office. But they’re just as effective, more convenient, and usually less expensive when you get them in your home.

If you get your Medicare benefits through a Medicare Advantage health plan (instead of Original Medicare), check with the plan for details about how it provides your Medicare-covered home health benefits.

To be eligible for home health services, you must be under a doctor’s care and receive your services under a plan of care established and reviewed regularly by a physician. He or she also needs to certify that you need one or more home health services.

In addition, you must be homebound and have a doctor’s certification to that effect. (Being homebound means leaving your home isn’t recommended because of your condition, or your condition keeps you from leaving without using a wheelchair or walker, or getting help from another person.) Also, you must get your services from a home health agency that is Medicare-approved.

If you meet the criteria, Medicare pays for covered home health services for as long as you’re eligible and your doctor certifies that you need them.

Skilled nursing services are covered when they’re given on a part-time or intermittent basis. In order for Medicare to cover such care, it must be necessary and ordered by your doctor for your specific condition. You must not need full-time nursing care.

Skilled nursing services are given by either a registered nurse or a licensed practical nurse under an RN’s supervision. Nurses provide direct care and teach you and your caregivers about your care. Examples of skilled nursing care include: giving IV drugs, shots, or tube feedings; changing dressings; and teaching about prescription drugs or diabetes care. Any service that could be done safely by a non-medical person (or by yourself) without the supervision of a nurse, isn’t skilled nursing care.

Physical therapy, occupational therapy, and speech-language pathology services have to be specific, safe, and effective treatments for your condition.

Before your home health care begins, the home health agency should tell you how much of your bill Medicare will pay. The agency should also tell you if any items or services they give you aren’t covered by Medicare, and how much you’ll have to pay for them. This should be explained by both talking with you and in writing. The agency should give you a notice called the Home Health Advance Beneficiary Notice (HHABN) before giving you services and supplies that Medicare doesn’t cover.

What isn’t covered? Some examples:

• 24-hour-a-day care at home;
• Meals delivered to your home;
• Homemaker services like shopping, cleaning, and laundry (when this is the only care you need, and when these services aren’t related to your plan of care);
• Personal care given by home health aides like bathing, dressing, and using the bathroom (when this is the only care you need).

If your doctor decides you need home health care, you can choose from among the Medicare-certified agencies in your area. (However, Medicare Advantage plans may require that you get home health services only from agencies they contract with.)

One good way to look for a home health agency is by using Medicare’s “Home Health Compare” web tool, at www.medicare.gov/HHCompare. This tool lets you compare home health agencies by the types of services they offer and the quality of care they provide.

For more details on Medicare’s home health benefit, please read our booklet, “Medicare and Home Health Care.” It’s online at http://www.medicare.gov/publications/pubs/pdf/10969.pdf.

David Sayen is Medicare’s regional administrator for California, Arizona, Nevada, Hawaii, and the Pacific Trust Territories.

Most older Americans (63%) are very worried they won’t be able to pay for their medical care as they age, according to a report by The Insured Retirement Institute (IRI).  From information contained in the report, we should be worried.

According to an article in LifeHealthPro which reviewed the IRI report, people on Medicare can expect to spend well over $350,000 on their medical care and insurance premiums during their retirement years.

The LifeHealthPro article highlighted some of the findings in the IRI report:

● For 2012, Medicare Part B premiums will account for 8.2% of the average Social Security benefit, up from 5.1% in 2000.

● While the average Social Security check is 31% higher than it was in 2001, premiums for Medicare Part B have doubled.

● While 63% of all boomers lack confidence in their ability to cover medical expenses in retirement, the concern is most pronounced among younger boomers: 72% percent of boomers ages 50-54 are concerned about their ability to cover medical costs in retirement.

The full IRI report can be found here.

I recently wrote about my trip to Ireland and Northern Ireland where government health care systems cover most medical costs for older citizens. Losing their life savings to pay for health care is not an issue for most people in Ireland – or Europe. Health care costs are going up across the pond, but not as much as in the United States.  This comes back to the question I have asked before:  How much can older Americans be expected to pay for their Medical care? I guess that’s the trillion dollar question.

I received and email from the SCAN Foundation with a list of “10 things you should know about aging with dignity and independence”.  The list is an eye-opener… and a real bummer.

Here are some of the very interesting points from the email which will make you think about your plans for getting old…. or make you want to join the Hemlock Society.

70 percent of us who reach the age of 65 will need some form of care or services for an average of three years.

Research shows that 43 percent of Americans over the age of 55 have less than $25,000 saved for retirement.

In 2011, nursing home care cost an average of $78,110 a year for a semi-private room.

Assistance at home, such as a visit from a home health aide, costs on average $21,840 a year.

Only short-term rehabilitative care at home or in a nursing home is covered by Medicare. [note: Long-term care is not covered by Medicare.]

Medicaid pays for about half of all nursing home or home care services. However, should you need care, the only way to qualify is to spend nearly all of your assets. The nest egg you’ve worked hard all your life to build must be spent to qualify for help.

In 2010, spending on supportive services for adults age 65 and older was estimated to be $182 billion, and projected to increase to $684 billion by 2050. Such projections threaten both state and federal budgets.

Today, over 12 million Americans rely on these services and supports, with 58 percent of those individuals over the age of 65.  By 2050, it is predicted that this number will more than double, with 27 million Americans relying upon long-term services and supports.

Less than 10 percent of adults actually have purchased a long term care insurance policy.  According to experts, few people purchase it because it is expensive, rates have historically increased rapidly, and potential buyers can be denied coverage due to pre-existing conditions.

Despite the recognition of a looming crisis in caring for aging Americans, little has been done in the past 40 years to address this problem and create a healthy network of supports and services allowing Americans to age with dignity in the place we call home.

The federal health reform law created a number of opportunities to help older people and adults with disabilities remain in their homes and communities. It includes programs to help states provide more in-home care to low-income adults in need and ways to help those living in nursing homes to return to their homes and communities.

This last statement refers to one part of the Affordable Care Act which is actually on its deathbed. The Community Living Assistance Services and Supports (CLASS) program was to be a voluntary long-term care insurance plan which working people could pay into through deductions from their paychecks.  The money would  go into a government trust and could be used by CLASS participants to pay for in-home help when they are old and infirm.  The idea is to get people to put money aside for their long-term care needs so they don’t end up in a state-supported nursing home.

Sorry for the bummer news.  Enjoy your day!