If it is ordered by the Dr. then Medicare pays, hopefully they have a supplement. If you are having difficulties with Medicare, find out the reason if they denied payment. You can also get help from AARP. If she/he has a supplement from them or join. They have free legal advice
Medicare paid for PT AS long as they are making progress, then they no longer pay. Exactly why my mother no longer has PT lol. Evidently some have different Medicare than my mother since once she left rehab after 21 days, they paid nothing for nursing care. Neither does her Medicare supplement. Totally self pay. They only pay for nursing home/ home health care if you are improving, which is why they paid nothing for my stepfather with end stage dementia.
If you loved one is expected to recover and makes progress they pay but if not they don’t. My mother is 92, dementia, A-fib, plus other chronic problems so after she broke her hip they paid until she could no longer progress due to the dementia ( has to now use a walker but is still a severe fall risk due to balance ) . So it’s not just the heart condition , it’s what else is wrong that may keep them from fully recovering.
Go to the Medicare web sight and you can find your answer. When my wife was coming home after she had surgery. She has traditional Medicare and the length of time in a Rehab hospital was limited to 21 days. It can get complicated so the social worker at the hospital, they most everything about Medicare, might be a help also.
The limit is 100 days but Medicare only pays 100% the first 20days. 21 to 100 days is 50% with maybe supplimental paying some. My Mom paid $150 a day some yrs back.
Medicare will pay for 21 Days of INHOME care after one gets Home from the Hospital. After this, You will either have to Pony up the Pay to keep your Caregiver or Go into a Facility.
Respectfully this is not correct. The 21 days are the amount Medicare pays 100% of in patient rehab; day 22 there is a share of cost with Medicare and whatever the secondary policy will pay. This may cost the patient money out of pocket as well if their insurance doesn’t cover 100% of the 20% Medicare will not pay. As for in home care the length of visits/time Medicare covers is usually not more than 60 days but depends on acuity. If the patient reaches criteria for discharge from homecare services before this, which is the norm, they are discharged from HC services by the RN. PT can still stay in the home if the person is making progress but not more than 60 days. There is a process for recertification but this has to be proven to be really necessary. Homecare staff visits average 30 minutes to 1 hour. They are not in the home to provide 24 hr care.
Traditional Medicare pays 100%. Your doctor may have a HHC company already established that he gives the order to. Or you can choose a HHC company that you want to use. Perhaps you know someone who is happy with theirs and is already in your area. Call them and discuss your LOs situation. (You can find a list on Medicare.gov and see how they are rated). They will communicate with the doctor for you. It’s what they do. We choose our company because we knew one of the RNs. My mom needed all the services you mentioned. She had them about 6 years. When my aunt (92) needed HH I called the same company. They have been with her about that long now. While both of them had/have great Medigap policies, Medicare pays 100%. I have no personal experience with the advantage plans or Medicaid. EDIT: oh and they DO pay for an aide (CNA) to come twice a week. In my mom’s case they came three times a week. My aunt, only twice. They did make some comments about stopping the bathing (a couple of years ago) because they were worried about changes they had heard rumors about within the program. They didn’t stop. Also when I hired someone to cook they made sure that person wasn’t there to bath aunt. I assured them they weren’t qualified to do that and we got past that hurdle. Over about a 10 yr period that’s the only deviation. They have never said the nurse would stop. But it is an individual matter. Really depends on your LO’s needs. There is a sweet spot where the service is available for those who meet the requirements. People have different experiences. I’m not sure why. But the HHC will know if your LO meets their requirements physically and if your insurance will pay. The nurses or CNAs, or even the therapist, don’t always know about Medicare regulations, again that’s just been my experience. There is a LOT to learn with Medicare.
Since there are so many different answers below and I don't understand Medicare Advantages all that much, I would talk to the Homecare Service the doctor recommends. They should know who pays what. You may end up owing a small amount after Medicare and your suppliment pay their share.
But in my experience with straight Medicare, they pay for Homecare PT/OT, an aide for bathing and an RN to check vitals and do blood draws. A nurse will come to admit the patient so ask questions then too.
The member’s insurance company. You may have to make sure he has coverage by calling his insurance company as well. Also if he has a Medicare Advantage Plan he will need to be placed in an “in-network” cardiac rehab center. Any non in-network cost is the patients responsibility.
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If you loved one is expected to recover and makes progress they pay but if not they don’t. My mother is 92, dementia, A-fib, plus other chronic problems so after she broke her hip they paid until she could no longer progress due to the dementia ( has to now use a walker but is still a severe fall risk due to balance ) . So it’s not just the heart condition , it’s what else is wrong that may keep them from fully recovering.
As for in home care the length of visits/time Medicare covers is usually not more than 60 days but depends on acuity. If the patient reaches criteria for discharge from homecare services before this, which is the norm, they are discharged from HC services by the RN. PT can still stay in the home if the person is making progress but not more than 60 days. There is a process for recertification but this has to be proven to be really necessary.
Homecare staff visits average 30 minutes to 1 hour. They are not in the home to provide 24 hr care.
Your doctor may have a HHC company already established that he gives the order to. Or you can choose a HHC company that you want to use. Perhaps you know someone who is happy with theirs and is already in your area. Call them and discuss your LOs situation. (You can find a list on Medicare.gov and see how they are rated).
They will communicate with the doctor for you. It’s what they do. We choose our company because we knew one of the RNs.
My mom needed all the services you mentioned. She had them about 6 years.
When my aunt (92) needed HH I called the same company. They have been with her about that long now.
While both of them had/have great Medigap policies, Medicare pays 100%.
I have no personal experience with the advantage plans or Medicaid.
EDIT: oh and they DO pay for an aide (CNA) to come twice a week. In my mom’s case they came three times a week. My aunt, only twice. They did make some comments about stopping the bathing (a couple of years ago) because they were worried about changes they had heard rumors about within the program. They didn’t stop.
Also when I hired someone to cook they made sure that person wasn’t there to bath aunt. I assured them they weren’t qualified to do that and we got past that hurdle. Over about a 10 yr period that’s the only deviation. They have never said the nurse would stop. But it is an individual matter. Really depends on your LO’s needs. There is a sweet spot where the service is available for those who meet the requirements.
People have different experiences. I’m not sure why. But the HHC will know if your LO meets their requirements physically and if your insurance will pay.
The nurses or CNAs, or even the therapist, don’t always know about Medicare regulations, again that’s just been my experience. There is a LOT to learn with Medicare.
But in my experience with straight Medicare, they pay for Homecare PT/OT, an aide for bathing and an RN to check vitals and do blood draws.
A nurse will come to admit the patient so ask questions then too.