Does Aetna Medicare Cover Home Health Care Services?

If you’re wondering, “does Aetna Medicare cover home health care services?”, you’re not alone. The clear-cut answer is yes, Aetna Medicare provides coverage for various home health care services when they meet certain conditions.

This coverage can include skilled nursing care, therapy services, and home health aide support.

In this article, we’ll delve into the specifics of what these services include, the eligibility requirements you’ll need to meet, and how to navigate the process of getting the necessary home health care through Aetna Medicare.

 

Key Takeaways

 

  • Patients must meet specific requirements to qualify for Aetna Medicare coverage for home health services, such as being homebound, possessing a physician’s order, and using a Medicare-certified agency.

 

  • There are limitations and exclusions in Aetna Medicare’s home health care coverage; non-skilled care like long-term custodial care is not covered, and there are restrictions on service frequency and duration.

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Aetna Medicare and Home Health Care Services

 

Does Aetna Medicare Cover Home Health Care Services?, Aetna Medicare and Home Health Care Services

 

Aetna Medicare offers coverage for a broad spectrum of home health care services through their Aetna insurance plan, each tailored to meet the specific health needs of each patient.

These services range from skilled nursing care to therapy services, with each having its own set of eligibility criteria and provisions.

We will discuss these services further.

 

Skilled Nursing Care

Skilled nursing care, provided by registered or licensed practical nurses, forms an integral part of home health care services, including skilled nursing service offered at a skilled nursing facility.

These services are deemed medically necessary and are therefore covered by Aetna Medicare. The primary objective of skilled nursing care is to improve the patient’s health condition or at least sustain their current state to prevent deterioration.

The duration of visits for home health skilled nursing care can range from a consecutive 4-hour period of care to intermittent visits lasting up to 4 hours, provided on an intermittent or hourly basis.

 

Home Health Aide Services

Home health aide services, which include personal care and light housekeeping, are another facet of home health care services covered by Aetna Medicare for eligible patients.

An eligible patient, in this context, is someone who has trouble leaving home due to illness or injury and typically only leaves home with considerable effort, with infrequent and short absences.

These human services are aimed at enhancing the overall well-being of the patient by supporting them in their daily living activities.

 

Therapy Services

Therapy services form another crucial component of Aetna Medicare’s home health care coverage. These include physical, occupational, and speech therapy services, which are prescribed by a physician.

The benefits of these therapies are diverse, ranging from addressing muscle weakness and neuromuscular conditions in physical therapy to restoring performance skills lost through injury in occupational therapy.

Speech therapy, on the other hand, is covered when deemed medically necessary, unless provided in an educational setting.

 

Eligibility Requirements for Aetna Medicare Home Health Care Coverage

 

Does Aetna Medicare Cover Home Health Care Services?, Eligibility Requirements for Aetna Medicare Home Health Care Coverage

 

To avail Aetna Medicare’s home health care coverage, patients must meet certain eligibility requirements. These criteria include homebound status, a physician’s order, and receiving care from a Medicare-certified agency.

We will examine each of these requirements more closely.

 

Homebound Status

Homebound status is a prerequisite for Aetna Medicare home health care coverage. This implies that patients must have trouble leaving home without assistance, often requiring the aid of another individual or a supportive device like a wheelchair or walker.

The responsibility of certifying a patient’s homebound status lies with a Medicare-certified home health agency.

 

Physician’s Order

A physician’s order is another crucial requirement for securing Aetna Medicare home health care coverage. This order should specify the need for skilled nursing services or home health aide in specific situations, substantiating the medical necessity of the services.

In the event of denial of a physician’s order for home health care by Aetna Medicare, a medical appeal can be requested.

 

Medicare-Certified Agency

Receiving care from a Medicare-certified agency is the third main eligibility requirement for Aetna Medicare’s home health care coverage.

Such an agency guarantees compliance with federal standards for quality and safety in delivering essential care services.

Obtaining Medicare certification involves adherence to quality benchmarks and all Medicare regulations.

Limitations and Exclusions in Aetna Medicare Home Health Care Coverage

 

Does Aetna Medicare Cover Home Health Care Services?, Limitations and Exclusions in Aetna Medicare Home Health Care Coverage

 

While Aetna Medicare covers a broad range of home health care services, there are also certain limitations and exclusions to be aware of. These include non-skilled care and restrictions on the frequency and duration of services.

We will further analyze these aspects.

 

Non-Skilled Care

Non-skilled care, often referred to as custodial care, is not covered by Aetna Medicare. These services, provided by home health aides, do not meet the criteria for skilled nursing care, which is a prerequisite for Aetna Medicare coverage.

Examples of non-skilled care services include home health aides for long-term care, home infusion services, and assistance with activities of daily living.

 

Frequency and Duration of Services

Aetna Medicare also imposes constraints on the frequency and duration of home health care services. These limitations are determined by the patient’s specific needs and treatment plan.

For example, home health care visits are generally allowed for less than eight hours per day and fewer than seven days per week, with a maximum of 10 hours per month.

 

Alternative Healthcare Services Covered by Aetna Medicare

 

Does Aetna Medicare Cover Home Health Care Services?, Alternative Healthcare Services Covered by Aetna Medicare

 

For those who may not qualify for home health care, Aetna Medicare provides coverage for alternative healthcare services, including Medicaid services. These options encompass telemedicine, outpatient rehabilitation, and hospice care.

We will further discuss these alternatives.

 

Telemedicine

Telemedicine enables patients to access medical care without leaving their homes, providing a convenient and efficient way to receive treatment. This digital platform has proven to be a powerful tool in delivering healthcare services remotely.

Covered by Aetna Medicare, telemedicine services enable virtual consultations with in-network primary care providers and physicians, accessible round the clock.

To access these services, members can either log in to their account on the Aetna Medicare website or directly contact their provider.

 

Outpatient Rehabilitation

Outpatient rehabilitation is another alternative healthcare service covered by Aetna Medicare.

These services, which include physical therapy, occupational therapy, and speech-language pathology, provide rehabilitation to patients without necessitating a hospital stay. The frequency of these services is plan-dependent, and no prior authorization is required.

 

Hospice Care

Hospice care, a specialized form of healthcare service offered to terminally ill individuals, is also covered by Aetna Medicare.

Hospice care encompasses:

  • Medical services

 

  • Medications

 

  • Supplies for the terminal illness

 

  • Coverage for counseling services.

 

Eligibility for hospice care coverage includes the option for two 90-day benefit periods, followed by an unlimited number of 60-day benefit periods.

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Choosing the Right Home Health Care Provider

 

Does Aetna Medicare Cover Home Health Care Services?, Choosing the Right Home Health Care Provider

 

Selecting the appropriate home health care provider is key to receiving optimal care. This process entails examining providers, assessing care quality, and confirming coverage with insurance providers.

We will further analyze these components.

 

Research Providers

While examining providers, it’s pertinent to evaluate local licensed, accredited, and Medicare-certified agencies. These providers have demonstrated compliance with the essential certification criteria, ensuring they deliver high-quality care.

You can verify their license and accreditation through the Quality Check website and the CMS website.

 

Evaluate Quality of Care

The quality of care provided by home health care agencies can be assessed through patient outcomes and satisfaction scores. These measures provide valuable insights into the care quality and impact on clinical outcomes.

 

Verify Insurance Coverage

Finally, confirming the in-network status of a home health care provider with Aetna Medicare is necessary to prevent unforeseen costs. You can do this by logging into your account on the Aetna Medicare website or directly contacting Aetna Medicare.

Managing Out-of-Pocket Costs for Home Health Care Services

Does Aetna Medicare Cover Home Health Care Services?, Managing Out-of-Pocket Costs for Home Health Care Services

Understanding which services Aetna Medicare covers and which it can’t assist in managing your out-of-pocket expenses. In addition, being aware of co-pays and deductibles associated with home health care services can help you plan for potential costs.

 

Covered vs. Non-Covered Services

Comprehending the difference between covered and non-covered services is key. Aetna Medicare typically covers services like:

  • home health aides

 

  • physical therapy

 

  • skilled nursing care

 

  • home meal delivery

 

However, it does not cover custodial care services, which are mainly focused on assisting with daily living activities unless they are considered medically necessary.

 

Co-Pays and Deductibles

Co-pays and deductibles are also important considerations when managing out-of-pocket costs. Co-pays are a set fee patients pay for each service, while deductibles are the amount patients need to cover before their insurance starts.

Grasping these terms can assist in managing your expenses in a better manner.

Preparing Your Home for Home Health Care Services

Once you’ve chosen a provider and understood your coverage, it’s time to prepare your home for home health care services. Ensuring a safe and comfortable environment for both the patient and the healthcare provider can drastically improve the quality of home health services provided.

Summary

In conclusion, understanding your Aetna Medicare coverage for home health care services is important for managing your health needs effectively.

Whether it’s skilled nursing care, home health aide services, or alternative healthcare services like telemedicine, knowing what’s covered can help you plan better and avoid unexpected costs.

Remember to choose your provider carefully, verify their network status, and prepare your home for a safe and comfortable care experience.

 

Frequently Asked Questions

 

  Does Medicare pay for home assistants?

Medicare will cover part-time or intermittent home health aide services only if they’re performed in conjunction with skilled nursing, physical therapy, speech-language pathology, or occupational therapy.

Therefore, Medicare does provide coverage for home assistant services in certain circumstances.

 

  What is the difference between Aetna Medicare and regular Medicare?

Aetna Medicare is a type of Medicare Advantage plan provided by a private insurance company, offering additional benefits beyond what Original Medicare provides.

 

→  Why does Aetna want to do a home visit?

Aetna wants to do a home visit to provide convenient, safe options for managing your care, prioritizing your health, and ensuring you feel safe at home.

 

→  Does Aetna Medicare cover palliative care?

Yes, Aetna’s Medicare Advantage plans cover palliative care services as part of their medical benefits and include a network of palliative care providers in the community.

 

 What types of home health care services are covered by Aetna Medicare?

Aetna Medicare covers a wide range of services including home health aides, physical therapy, skilled nursing care, and home meal delivery.

These services can provide comprehensive care at home for eligible individuals.

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Speak with a licensed insurance agent

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Russell Noga
( Medicare Expert )

Russell Noga is the CEO of ZRN Health & Financial Services, and head content editor of several Medicare insurance online publications. He has over 15 years of experience as a licensed Medicare insurance broker helping Medicare beneficiaries learn about Medicare, Medicare Advantage Plans, Medigap insurance, and Medicare Part D prescription drug plans.