Skilled Services

Skilled services are termed so because they are administered by professional and technical staff that are trained and licensed to do so, unlike our caregiver services that are staffed by highly trained individuals without required licenses (unskilled).

Under our skilled services are the following:

• Skilled Nursing

• Physical Therapy

• Occupational Therapy

• Wound Care

• Home Health Aide

• Telemonitoring

Eligibility

Skilled services are typically rarely paid out of pocket by clients due to high costs associated with visits from licensed professionals.

The easiest and lowest cost way to get home health services covered is with Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance).

These cover the majority of services like the following:

• Skilled Nursing

• Physical Therapy

• Occupational Therapy

• Home Health Aide - only if receiving skilled nursing and/or therapy. Medicare does not cover HHA only clients.

• Durable Medical Equipment and medical supplies for use at home.

  • Medicare typically does not cover around the clock care. That is a hospice feature.

All people with Medicare Part A and/or B who meet the following conditions are covered:

• You must be under the care of a doctor, and you must be getting services under a plan of care created and reviewed regularly by a doctor.

• You must need, and a doctor must certify that you need, one or more of these:

• Intermittent skilled nursing care (other than drawing blood).

• Physical therapy, speech-language pathology, or continued occupational therapy services. These services are covered only when the services are specific, safe and an effective treatment for your condition. The amount, frequency and time period of the services needs to be reasonable, and they need to be complex or only qualified therapists can do them safely and effectively.

• To be eligible, either:

  • 1) Your condition must be expected to improve in a reasonable and generally predictable period of time, or

  • 2) You need a skilled therapist to safely and effectively make a maintenance program for your condition, or

  • 3) You need a skilled therapist to safely and effectively do maintenance therapy for your condition.

  • 4) The home health agency caring for you is approved by Medicare (Medicare certified).

• You must be homebound, and a doctor must certify that you're homebound.

  • You're not eligible for the home health benefit if you need more than part-time or "intermittent" skilled nursing care. You may leave home for medical treatment or short, infrequent absences for non-medical reasons, like attending religious services. You can still get home health care if you attend adult day care.

Other ways to get coverage

As mentioned above, direct Medicare Part A/B is the best way to get coverage and have to pay little to nothing out of pocket. There are many other insurance plans that cover home health services like:

• The VA. - The U.S. Department of Veterans Affairs covers a wide range of skilled and unskilled home health services.

• Medicare Advantage Plans - There are many Medicare Advantage plans that cover home health services. Clients should be very careful with the insurance policies offered here because many of these type of insurance policies because they are typically promoted to offer "low costs or free drugs" in addition to Part A/B services, when really they cut back on some services like the ones under home health. This can lead to out of pocket costs for the client.