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Does Medicare Cover Home Health Care For Parkinson’s Patients

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Progression Of Parkinsons Disease

Medicare and Parkinsons: What You Need to Know

Symptoms of Parkinsons disease develop slowly and gradually progress over time. Each person is affected differently and the rate of progression varies greatly between individuals. Parkinsons disease in itself does not directly cause people to die, although the symptoms do get worse over time. It is possible to live with Parkinsons disease for more then 20+ years.

Parkinsons Disease And Medicare Coverage

Medicare is made up of multiple parts. Each part covers different services and treatments that youll need to manage Parkinsons.

Original Medicare is composed of Part A and Part B. Part A covers a portion of your inpatient hospitalization costs. Part B provides coverage of outpatient medical needs including those for diagnosis, treatment, and prevention.

Does Medicare Cover Physical Therapy For Parkinsons

In the past, getting physical therapy under Medicare has been difficult for people with Parkinsons because Medicare used to require doctors and therapists to attest that the therapy would improve the persons condition. For people with Parkinsons, therapy is often performed simply to maintain their current level of health and mobility.

This has changed in recent years and now medical necessity can be attained without requiring improvement. Caps on therapy were also removed in 2018, which now allows people with Parkinsons access to more therapy each year.

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Medicare Coverage By Part

  • any age and have a disability
  • any age and have end stage renal disease

However, there are also some specific Medicare plans that people with dementia may be eligible for. In these cases, a diagnosis of dementia may be required:

  • Special needs plans :SNPs are a special group of Advantage plans that specifically address the needs of people with specific health conditions, including dementia. Coordination of care is also often included.
  • Chronic care management services : If you have dementia and at least one more chronic condition, you may be eligible for CCMR. CCMR includes development of a care plan, coordination of care and medications, and 24/7 access to a qualified healthcare professional for health needs.

Dementia happens when you lose cognitive abilities like memory, thinking, and decision-making. This can significantly impact social function and activities of daily living. For example, a person with dementia may have difficulty:

  • recalling people, old memories, or directions
  • carrying out daily tasks independently
  • communicating or finding the right words
  • solving problems
  • paying attention
  • controlling their emotions

There isnt just one type of dementia. There are actually several types, each with different characteristics. They include:

Will Medicare Cover My Parkinsons Disease

Does Medicare provide cover for Parkinson

Just shy of one million people in the U.S. are living with Parkinsons disease and ten times that amount are living with the disease worldwide. An estimated 60,000 Americans are diagnosed with Parkinsons each year.i

If you are among these numbers, you may be wondering how you can use your Medicare benefits to manage your Parkinsons. Lets break down the various parts of Medicare to see how you can do this.

What youll learn:

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Flexibility Affordability And Independence

Sometimes all you need is a little help, sometimes a lot. In either case, A Better Living Home Care can provide a qualified, trusted caregiver suited to you and your family at a fraction of the cost of an assisted living facility. The host of non-medical services and the quality of one-on-one care at home provided by the right caregiver cant be matched by any facility.

When Care Comes To You: Tips For Using Home Health Aides Pts And Ots

In this 1-hour webinar physical therapist Julie Hershberg explains the different roles of each professional as well as questions to ask to ensure you find a person that is a good fit for you and how to harness the power of your health care team including your home health aide, physical therapy and occupational therapist.

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What Are The Risk Factors

Johns Hopkins Medicine finds that between 10% and 20% of Parkinsons cases have a genetic link, leaving the rest stemming from unknown causes.v However, there is a set of risk factors including:

  • Advancing age the average person experiences onset around 60 years old
  • Gender men are more likely to develop Parkinsons
  • Environmental causes chemical exposure and work with heavy metals, solvents, and detergents, though this is not a primary cause
  • Trauma to the head boxers such as Muhammed Ali, who have experienced blows to the head, have developed Parkinsons

Those who have a genetic link are several times more likely to develop the disease than those without that hereditary factor.

Who Can Receive Home Care Covered By Medicare

How Medicare Works for Parkinson’s Disease – Boomer Benefits Medicare Expert Q& A

Individuals must have coverage through Medicare Part A and/or Medicare Part B and meet the following four criteria as set forth by Medicare.gov:

  • Eligible recipients must be under the care of a doctor. The doctor must prescribe a plan of care that involves medically necessary services for the treatment or maintenance of a health condition. This care is intended to be short term, so the doctor is required to re-certify the plan of care every 60 days.
  • Eligible recipients must be certified by a doctor as homebound. This means it requires a considerable and taxing effort to leave the home because of reliance on a mobility aid , special transportation, or the assistance of another person to do so. An individual does not have to be bedridden to be considered homebound and can still qualify even if they are able to leave home for medical treatments, adult day care, and short, infrequent nonmedical outings, such as religious services and family gatherings.
  • Eligible recipients must have a doctors certification of need for at least one of the following services:
  • Home health care services must be provided by a Medicare-certified home health care agency.
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    How To Choose An Assisted Living Facility For Parkinsons Patients

    Before you begin your search for an assisted living facility, talk to the seniors physician about their special needs. The physician may not be permitted to share private medical information , but he or she should be able to offer guidance on the patients current and future care needs.

    Once you have a firm idea of the level of care that the Parkinsons patient requires, it simply becomes a matter of narrowing down a list of assisted living facilities that offer that level of care. We recommend compiling a list of several qualifying facilities, then visiting the facilities and speaking with the staff to determine the best fit for the senior in question.

    Most assisted living facilities allow prospective residents to spend the day at their facility to assess the fit in person, with some communities even allowing a weekend stay to enjoy the full experience. Youll need to exercise caution with such extended visits when the Parkinsons patient is experiencing memory issues as the new environment may be overwhelming, but its a great way to test out your favorite community to ensure its a good fit.

    As youre doing your due diligence speaking with the community director and staff, dont be afraid to ask direct questions about how they are qualified to care for Parkinsons patients. Specialized facilities and units often follow a popular, medically-backed care/treatment strategy, which you can further research online.

    Causes Of Parkinsons Disease

    Parkinsons disease is an idiopathic illness, which means that its cause is unknown.

    The signs and symptoms it present are caused by the loss of nerve cells in the part of the brain called substantia nigra.

    This part of the brain is responsible for the production of dopamine, a neurotransmitter that links the brain and nervous system to coordinate body movements.

    Loss of dopamine results in uncoordinated body movements, thereby producing the signs and symptoms of the disease.

    Though the exact cause of Parkinsons disease is still unknown, there are possible explanations that may be responsible for the condition, such as:

    • Genetics. Studies have shown that a minority of cases of PD have genetic involvement.
    • Environmental factors. Exposure to pesticides, herbicides, and industrial pollution is now being looked at as a possible cause of PD. However, the results are still inconclusive.
    • Presence of Lewy bodies. Lewy bodies are clumps of substances in the brain cells. These are often seen in people with Parkinsons disease. The studies about them are still inconclusive, but researchers believe that these substances hold useful information to what causes PD. Researchers are also focusing into alpha-synuclein found in the Lewy bodies.

    The following are the associated risk factors in developing Parkinsons disease:

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    What Is A Skilled Nursing Facility

    A skilled nursing facility is a healthcare center with at least one full-time registered nurse on- site and a doctor on call. It provides resident access to 24-hour care from nurses and certified nursing assistants. Skilled nursing facilities provides more care than assisted living facilities, which only help with day-to-day activities.

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    How Much Will I Have To Pay If I Qualify

    Do You Know What Therapeutic Care Medicare Covers?

    With Original Medicare coverage , eligible seniors will pay nothing for home health care services that are ordered by a doctor and provided by a certified home health agency. Any additional services provided outside of the approved care plan will not be covered and must be paid for out of pocket.

    Be aware that before services begin, the home health agency should provide an itemized receipt or plan of care that identifies what is eligible for Medicare coverage and what is not. A written notice called the Advance Beneficiary Notice of Noncoverage will detail any services and durable medical equipment that Medicare will not pay for as well as the costs the patient will be responsible for.

    Use the guide below to determine the combination of payment options that will help your family cover home care costs.

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    Difficulties With Activities Of Daily Living

    ADLs refer to basic personal care tasks including bathing, dressing, eating, mobilizing, and toileting.

    Individuals with Parkinsons disease may have problems with mobilizing, freezing in place, bathing, grooming, toileting, dressing, eating, driving, travelling, as well as safety at home. A person has more difficulty performing these ADLs as the disease progresses due to increased muscle and cognitive impairment.

    It can be hard to for individuals to adjust to these changes but there are ways to provide support and to promote as much independence and quality of life as possible.

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    Will Medicare Cover Physical Occupational And Speech Therapy

    Medicare will pay for physical therapy when its required to help patients regain movement or strength following an injury or illness. Similarly, it will pay for occupational therapy to restore functionality and speech pathology to help patients regain the ability to communicate.

    However, Medicare will only pay for these services if the patients condition is expected to improve in a reasonable, predictable amount of time, and if the patient truly needs a skilled therapist to administer a maintenance program to treat the injury or illness at hand.

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    Medicare Coverage For Parkinsons Disease

    • Medicare covers medications, therapies, and other services involved treating Parkinsons disease and its symptoms.
    • Physical therapy, occupational therapy, and speech therapy are all included in this coverage.
    • You can expect some out-of-pockets costs, even with your Medicare coverage.

    Medicare covers medically necessary treatments for Parkinsons disease, including medications, different types of therapy, and hospital stays. Based on the type of coverage you have, you may have some out-of-pocket expenses, such as copays, coinsurance, and premiums.

    Medicare may not cover all of the services youll need, such as assistance for normal daily living.

    If you or a loved one has Parkinsons disease, its important for you to understand which parts of Medicare cover which treatments to avoid large, unexpected expenses.

    Does Medicare Cover Home Health Care For Dementia

    4 Seniors: Does Medicare cover home health care?

    Medicare covers home health care for patients with dementia if patients have a doctors order for it, are considered homebound and have a need for intermittent nursing or physical, speech or occupational therapy.

    Home health agencies like Amedisys use a comprehensive assessment and interdisciplinary approach to treat patients with psychiatric diagnoses like dementia.

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    Does Medicare Pay For In

    In-home care is designed to support activities of daily living while maintaining a persons quality of life and preserving their dignity. There are many health conditions that may require help from a caregiver, such as Parkinsons disease, dementia, cancer, spinal cord or traumatic brain injuries, development disabilities, HIV/AIDS, advanced heart disease, stroke, multiple sclerosis, debilitating arthritis, or advanced diabetes. While many elderly individuals prefer to remain in their homes as they age, not all have this option due to financial challenges. In some instances, Medicare will cover in-home health care services if a patient meets certain eligibility requirements.

    Does Medicare Cover Durable Medical Equipment

    Medicare will cover the cost of medically necessary equipment prescribed by a doctor for in-home use. This includes items such as canes or walkers, wheelchairs, blood sugar monitors, nebulizers, oxygen, and hospital beds. Patients typically pay 20 percent of the Medicare-approved amount for such equipment, as well as any remaining deductible under Part B.

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    Medicare Supplement Plans Or Medigap

    If you have original Medicare , you may be able to purchase a Medicare supplement plan, also called Medigap.

    Some Medigap plans pay for the coinsurance costs for Part B, which may help you pay for home health services. However, these plans dont offer expanded home health service coverage.

    Some people choose to purchase separate long-term care insurance, which isnt a part of Medicare. These policies may help to cover more home health care services and for longer time periods than Medicare. However, the policies vary and do represent an extra cost to seniors.

    What Are Medicare’s Coverage Options

    Does Medicare Cover Home Health Care For Parkinsons Patients

    Medicare is offered through the federal government as a fee-for-service program, designed to provide affordable health insurance coverage to elderly and disabled Americans. Medicare has two parts: Part A and Part B .

    Part A Medicare coverage includes:

    • All normal hospital services
    • Transfusion of blood and blood components provided on an outpatient basis
    • Out-patient surgery

    Part B Medicare benefits require that you pay a monthly premium. You must also be entitled to Part A benefits to receive Part B benefits.

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    Medicare Supplement Coverage And Parkinsons Care

    Medicare Supplement Insurance plans can help bridge the gap between Original Medicare and your medical costs. Also known as Medigap, these plans can address the following:

    • Lengthier hospitalizations and room and board in skilled nursing facilities
    • Physician charges that exceed Medicare-allowed costs for certain procedures
    • Coverage outside the United States and Canada

    According to the Parkinsons Foundationiii, elements of a good Medigap policy include:

    • Hospitalization coverage for up to a year or more beyond what Original Medicare allows
    • Coverage outside the U.S. and Canada
    • Eighty percent or more coverage for out-of-pocket doctor or surgeon charges

    There are 10 different standard Medigap plans named after letters of the alphabet. Listed in order of popularity, Medigap Plan G, Plan N and Plan A are commonly found to cover the services list above.

    Remember that under federal law, you have six months from the time you start with Medicare to get guaranteed Medigap acceptance. Make sure you sign up in a timely manner in order to take advantage of this, or you may be subjected to medical underwriting when applying for a policy.

    What To Expect When A Loved One Has Parkinsons Disease

    Parkinsons disease is a progressive neurological disorder that causes a gradual loss of muscle control. Although the disorder generally occurs in elderly people, it is occasionally seen in younger adults. In fact, roughly 5-to-10% of all Parkinsons disease cases occur before the age of 50.

    Parkinsons disease usually evolves in five distinct stages:

    It is important to remember that Parkinsons disease affects each patient differently. While some may remain in Stage 1 for years, others advance quickly. Some people might even skip one more stage of disease progression entirely.

    There is no cure for Parkinsons disease, but prescription medications, deep brain stimulation, and certain therapies will usually alleviate or lessen symptoms. A healthy diet and regular exercise can also help people with Parkinsons disease improve muscle strength and balance.

    While Parkinsons disease itself is not fatal, its debilitating effects do increase the potential for deadly complications. Because swallowing issues may cause aspiration of food or liquids into their lungs, pneumonia is the most common cause of death among people with Parkinsons disease. Worsening mobility and balance problems also increase their risk for fatal falls.

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    Medicare Coverage Of Home Care

    In order to receive home care under Medicare:

    • You must be home-bound.
    • Your doctor must certify a plan of care.
    • Care must be needed on an intermittent basis.
    • Care cannot exceed 35-hours per week or eight hours per day.
    • Physical or speech therapy must be provided on a “necessary and reasonable” basis. There are restrictions on the number of days or hours per week of these therapies.
    • If you qualify for home health care, you are entitled to a home health aide to provide some personal care.

    When Should You Start Palliative Care For Parkinsons

    Medicare Coverage and Payment of Virtual Services

    You can start palliative care for Parkinsons at any time. Palliative care can help anyone who has a complex and progressive condition like Parkisons.

    Although many people wait until their condition has progressed or until they are in the later stages of Parkinsons to seek out an option such as palliative care, you might get more benefit from starting this care earlier.

    That way, youll have a supportive team with you over the years that can help you manage your diagnosis.

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