Navigating Medicare when it comes to Home Care in NYC

the flatiron building is an iconic landmark for seniors to get around the Flatiron District NYCAmong home health care companies in New York City, home care can provide numerous services for an elderly individual in their home when they are sick or may be wounded. Examples of services that home health services can provide are wound care, patient and caregiver education, intravenous therapy, nutrition therapy, injection, or monitoring of serious sicknesses. Home health care facilities strive to treat illness and injuries. They also push to help elderly individuals regain independent and become self-sufficient.

In order to start Home health care services a doctor’s order is needed to start care.

Once a doctor’s order is complete a home health care agency will usually order an initial assessment within the individual’s home to create a care plan and to discuss the wants and needs of the client. Home health agencies also keep in contact with each client’s doctors in order to talk about care and give progress updates.

Additionally, home health agencies can have their staff assist with eating or drinking, checking blood pressure, heart rate, blood pressure, and breathing. They can ensure a client is taking their medication correctly but Home Health Aides ae not allowed to touch medication. Furthermore, staff from a home health agency can check to see if the patient is in pain, on their safety in the home, to teach self-care, and to coordinate care on a regular basis between doctors, agencies, etc.

For elderly individuals covered by Medicare Part A (hospital insurance) and/or Medicare Part B (medical insurance) there are certain home health services that are eligible for coverage.

Some of these services include, intermittent skilled nursing care, physical therapy, speech-language pathology services, occupational services, and other services. Depending on the home health care agency these services can be coordinated. Each home care agency works with different organizations to coordinate care, and dependent on the agencies policies they would define which services they provide in coordination with Medicare. However please note that Medicare does not pay for 24-hour care at home, meals delivery, personal care, or home making services.

Any individual with Part A or Part B insurance is covered as long as they meet the following conditions;

  • they must be under a doctor’s care
  • and be getting services from a plan of care that is established by a doctor.

Additionally, a doctor needs to approve the need for nursing care, physical therapy, language pathology or occupational therapy. These services need to fit with pre-existing conditions and be practical, without a therapist that is trained they cannot be approved.

Furthermore, there are other conditions that must be met; the individuals condition must be expected to improve over the course of time, and a trained therapist must create and maintain a care plan in a safe and effective manner. Any home health agency that is provided care needs to be certified through Medicare and it must be approved by a doctor that you are home-bound. This does not mean that you cannot attend short medical treatments, religious services, or adult day care.

It does not cost any money for home health care services however 20% of the medicare-approved amount can be applied towards medical equipment. Additionally, some private pay home health care companies work with other companies to help provide Medicare services which is coordinated between the two. The Home Health Agency you choose should let you know before services begin how much Medicare will pay and if there are any services that are not covered by Medicare that are being requested as well as what they will cost. Each agency is required to send a notice called “Home Health Advance Beneficiary Notice” (HHABN) and this should state the services and/or supplies that Medicare is not covering.

We encourage anyone interested in start home health care with medicare to check out They have great resources to help answer any additional questions that you may have. Additionally, each home care agency may have their own specific policies regarding medicare listed on their website. In order to learn more about an individual agency, we recommend that you call them directly and request more information.

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