If you have become disabled and can no longer work due to a severe injury or medical condition, you might be entitled to receive Social Security Disability Insurance (SSDI) benefits. The application process can be confusing and time-consuming. For that reason, there are many misconceptions and gray areas that cause disabled individuals to not fully understand what they can expect from their SSDI benefits if they are approved.
One common question that many disabled individuals and their families have is if home health care services can be covered under SSDI benefits. The truth is, every individual’s case is different, and the benefits you receive completely depend upon the circumstances of your disability. Speaking with a skilled SSDI attorney, like those at the Law Offices of Dr. Bill LaTour, is always in your best interest, because they can explain the complicated system and help you get the most out of your benefits.
Does SSDI Cover Home Health Care?
If you are disabled and approved to receive SSDI benefits, you will be provided with Medicare insurance. However, keep in mind that you will not be eligible to receive those Medicare benefits until two years after your date of entitlement. Medicare will help pay for home health care as long as you or your loved one fit their list of requirements:
- You are considered homebound. This typically means that it is very difficult for you to leave your home or you cannot do so. Medicare deems an individual homebound if their doctor certifies that leaving the house would be harmful, because of their disability. Or, they cannot leave home without the help of another person or special equipment such as a wheelchair or walker.
- You require skilled care. This includes skilled nursing care from a licensed nurse on an intermittent basis. Intermittent means you need care as little as once every 60 days to as much as once a day for three weeks. If you need physical, speech, or occupational therapy services from a licensed therapist to help with your disability, this can also classify as requiring skilled care.
- You have attained doctor approval. Your doctor must sign a home health certification proving that you qualify for Medicare home health care because you are homebound and need skilled care. Furthermore, your doctor must confirm that a plan of care has been created for you and that it is regularly reviewed. These statements are generally combined in one form that is signed by your doctor and submitted to Medicare.
- You receive your care from a Medicare-certified home health agency (HHA).
What Types of Care Am I Eligible For Once I Qualify?
If you fall under all four of the above categories, then you qualify for home health care and are eligible to receive the following types of care:
- Skilled nursing provided up to seven days a week for no more than eight hours per day and 28 hours per week. Medicare may pay in full for services and care that can only be adequately and safely performed by a licensed nurse, such as injections, tube feedings, catheter changes, evaluation of a patient’s condition, and wound care.
- Skilled therapy services, such as physical, speech, or occupational therapy that can only be properly conducted by or with the supervision of a licensed therapist. The provided service must be considered reasonable and necessary in order to treat your illness or injury. These can include exercises to regain movement and strength to a particular area of the body, speech pathology exercises to strengthen language skills, or occupational therapy exercises to regain the ability to do everyday activities like eating and dressing by yourself. As long as these services call for a licensed therapist, Medicare should pay in order to maintain your condition and prevent it from worsening.
- Medicare will cover a home health aide if you or a loved one require personal care services, such as help with bathing, using the bathroom, or dressing. However, you do not qualify for Medicare home health benefits if all you require is personal care services. It will only be covered if you also require skilled care from a nurse or therapist.
- Medical social services. Medicare should cover home health care ordered by your doctor that’s meant to address social and emotional concerns you have related to your illness. This might include counseling or help to find resources in your community.
- Medical supplies and equipment. Medicare may pay in full for medical supplies and equipment needed for your care, such as wound dressings and catheters, so long as they are provided by the Medicare-certified home health agency.
What Home Health Care Services Are Not Covered?
Medicare does not cover every type of home healthcare service available. While you may use your SSDI monthly benefits to enlist any type of service you may need, the Medicare benefits you will begin to receive after 2 years will not cover 24 hour care in the home, homemaker services, such as cleaning, laundry, and grocery shopping, or, as previously stated, personal services provided by a home health aide, if that is the ONLY kind of care you require.
Need an SSDI Attorney to Assist You? Call The Law Offices of Dr. Bill LaTour
At the Law Offices of Dr. Bill LaTour, we understand how difficult life with a debilitating injury or illness can be. On top of that, the Social Security system is complex and tedious, making it difficult to always know what your options are and the exact benefits you are entitled to. A knowledgeable SSDI attorney can help make your life easier by clearing up any confusion surrounding the benefits you or your loved one might be entitled to, like home health care.
Only an experienced SSDI attorney can effectively evaluate your case and guide you through the stressful process. We’ve been helping disabled individuals in the Greater Los Angeles area, the Inland Empire, and Orange County get the disability benefits they need for years. Call Dr. Bill LaTour and his team today at 800-803-5090 or fill out our online form to schedule a free consultation.