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Understanding The Limitations of Medicare Coverage After A Hospitalization

Nothing is more discomforting than not knowing if you or a loved one will receive the adequate care for a full and safe recovery after hospitalization. When a patient is re-admitted to the hospital, it costs them, the government and the hospital additional expenses. More importantly, it causes the patient and their family emotional distress.

Neither Medicare nor traditional medical insurance covers many of the home healthcare services that can help reduce otherwise preventable injuries and hospital re-admissions. The services generally not covered under traditional insurance or Medicare, usually referred to as long-term care or "custodial care," include companion services, general supervision for health and safety and long-term home help with personal care and hygiene, meal preparation, transportation and errands.

Seniors especially require a variety of support services from caregivers for a safe and full recovery after being discharged from a hospital. However, as reported by Today’s Seniors, "Many excellent home healthcare agencies are not certified by Medicare. But it isn't because they aren't good enough. Instead, their nursing care plans only provide services that aren't paid for by Medicare, but which their clients need in order to remain in their own homes."

The problem that exists for and must be addressed by both patients and families is ensuring a loved one’s safety and recovery when in such a vulnerable condition, whether it be after hospitalization, illness or injury. Without the proper care, the patient often suffers preventable incidents resulting in additional and more costly care needs and reduction in independence.

Although Medicare does cover some home care, the patient must meet all of the following conditions:

  • The patient must be homebound and under a doctor’s care
  • The patient must need skilled nursing care or occupational, physical or speech therapy on at least an intermittent basis (that is, regularly but not continuously)
  • The services provided must be under a doctor’s supervision and performed as part of a home health care plan written specifically for that patient
  • The patient must be eligible for the Medicare program and the services ordered must be “medically reasonable and necessary”
  • The home healthcare agency providing the services must be certified by the Medicare program

Additionally, a recovering patient undergoing therapy must show continual improvement in order for Medicare to cover their care. If the patient doesn’t meet strict guidelines, Medicare considers the care custodial. At that point, when often faced with a major change in their needs due to the incident or illness that occurred, the patient becomes responsible for the cost of care.

Home healthcare services are designed to pick up where Medicare and other entities’ services leave off, ensuring your loved one’s continued wellbeing and independence. Sometimes a little bit of help from paid caregivers can provide an alternative to assisted living or a nursing home. For instance, EasyLiving’s caregivers provide our clients with support while they recuperate, whether it means coming in throughout the week to provide housekeeping and transportation, or staying with someone around the clock after surgery. While the client receives therapy or skilled nursing services, our caregivers assist as the person regains strength, ensuring proper nutrition and medication compliance so that the other services received have the chance to really work.