Below are the questions we hear most often from MS patients, family caregivers, and physicians across South Florida. If your question isn’t here, call us at (561) 693-1311 or use our intake form — we’ll answer in plain English.
Medicare Coverage
1. Does Medicare cover home health care for MS patients?
Yes. Original Medicare (Part A and Part B) covers skilled nursing, physical therapy, occupational therapy, speech-language pathology, medical social services, home health aide visits, and certain medical supplies for MS patients who meet four eligibility criteria — having a doctor’s order, a face-to-face encounter, a need for skilled intermittent care, and homebound status. Covered visits are paid at $0 copayment. The only out-of-pocket cost is 20% coinsurance on durable medical equipment after the Part B deductible.
2. What does "homebound" mean for Medicare home health?
Homebound does NOT mean bedridden. Medicare’s homebound definition has two parts: (1) leaving home requires the help of another person, a wheelchair, walker, cane, crutches, or special transportation, OR leaving home is medically inadvisable; AND (2) leaving home is normally not done, and when it is done, it requires considerable and taxing effort. Most MS patients with progressive symptoms meet this definition. You can still leave home for medical appointments, religious services, family events, and the salon.
3. How much does MS home health care cost?
$0 copay for covered home health visits under Original Medicare. There is no deductible for the visits themselves. Durable medical equipment (wheelchair, walker, hospital bed) carries a 20% coinsurance after the Part B annual deductible. If you have a Medicare Advantage (Part C) plan, copays vary by plan — we verify your specific plan benefits before care begins.
4. Do I have to be hospitalized first?
No. Many of our MS patients start home health care from home, never having been recently hospitalized. A doctor’s order, face-to-face encounter, and homebound status are required — but a hospital stay is not.
5. How long can I receive home health care?
As long as you continue to meet eligibility criteria. Care is delivered in 60-day episodes. At the end of each episode, your doctor reviews your status and decides whether to recertify. There is no lifetime limit and no maximum number of recertifications. Some MS patients receive home health care continuously for years.
6. What if I'm not getting better — will Medicare cut me off?
No. The Jimmo v. Sebelius Settlement (2013) confirmed that Medicare covers skilled care needed to maintain a patient’s condition or slow further deterioration — not just care expected to improve them. For MS patients, this protects ongoing coverage for maintenance therapy, skilled nursing for catheter management, and other long-term needs even when the underlying disease is progressive.
7. What if I need more care than Medicare covers?
Medicare home health is intermittent — typically up to 28 hours per week of combined nursing and aide services. Patients who need more help can bridge the gap with Florida Medicaid Home and Community-Based Services (HCBS) waivers, MS Focus Foundation grants, long-term care insurance, VA Aid & Attendance benefits, or private-pay services. Our medical social worker helps families assemble the right combination.
8. Can I keep my own neurologist?
Yes. Your neurologist remains your treating physician. We coordinate directly with them and communicate clinical updates after every visit. Home health complements specialist care — it does not replace it.
Homebound & Eligibility
9. Do I need a referral?
Yes. Medicare requires a physician’s order and face-to-face encounter to authorize home health. Your neurologist, primary care doctor, nurse practitioner, physician assistant, or clinical nurse specialist can refer you. We coordinate the paperwork.
10. How fast can care start?
Often within 24 to 48 hours of receiving a complete physician referral. From your first call, here’s the typical timeline: same-day insurance verification, same-day or next-day physician coordination, RN initial assessment within 24 to 48 hours, and skilled visits beginning immediately after.
11. Will Medicare pay for a 24-hour caregiver?
No. Medicare home health is intermittent care, not 24/7 coverage. Families needing 24-hour support typically combine Medicare home health with private-pay personal care, family caregiving, and (when eligible) Medicaid HCBS waivers.
12. Will Medicare pay a family member to provide care?
No. Medicare home health does not pay family caregivers. However, Florida’s Medicaid HCBS waivers (administered through the Agency for Persons with Disabilities and Statewide Medicaid Managed Care Long-Term Care) include programs that may pay family caregivers in some cases. Eligibility involves financial means-testing and clinical assessment.
13. What's the difference between home health care and home care?
Home health care includes skilled medical services (nursing, PT, OT, speech therapy) and is Medicare-covered when criteria are met. Home care (also called custodial or companion care) provides non-medical help with daily activities (bathing, meal prep, light housekeeping) and is generally NOT Medicare-covered alone.
14. What happens after the 60-day episode?
Your doctor reviews your clinical status and decides whether to recertify for another 60-day episode. There is no limit on the number of recertifications as long as eligibility continues to be met. The same plan of care can continue, or it can be modified based on changes in your needs.
Support
15. Can I have home health and hospice at the same time?
Generally no — for the same diagnosis. Medicare’s hospice benefit and home health benefit are usually mutually exclusive when both relate to the same condition. However, you can sometimes receive home health for an unrelated condition while in hospice. Our team helps families understand which benefit best matches their situation.
16. What if Medicare denies my claim?
You have appeal rights. Five levels of appeal exist: redetermination, reconsideration, ALJ hearing, Medicare Appeals Council, and federal court. Many denials based on lack of improvement potential are successfully appealed under the Jimmo Settlement. We help families navigate the process.
17. How do I check an agency's quality before choosing?
Look up any Medicare-certified home health agency at medicare.gov/care-compare. You’ll find two star ratings: Quality of Patient Care (clinical outcomes) and Patient Survey (HHCAHPS — what patients and families report). Look for agencies rated 3.5 stars or higher on both.
18. What's an Advance Beneficiary Notice (ABN)?
If your home health agency believes Medicare may not pay for a service or supply, federal law requires them to give you a written Advance Beneficiary Notice (ABN, Form CMS-R-131) BEFORE providing it. The ABN explains what won’t be covered, why, and what you’d have to pay. Always read the ABN. Always ask questions before you sign.
Other Common Questions
Do I need a referral from a medical doctor to see a chiropractor?
No, most patients can schedule directly without a referral. If your insurance requires one, we’ll guide you through the simple steps.
Can I combine chiropractic care with physical therapy or massage?
Yes. In fact, combining these services often produces better results by addressing both structural alignment and muscle health.
What should I do to maintain benefits between visits?
We provide simple exercises, stretching routines, and posture tips to support your recovery. Following these at home helps extend the benefits of care.
Are there any risks or side effects with chiropractic treatment?
Chiropractic is very safe when performed by licensed professionals. Side effects are typically mild and temporary, such as brief soreness or fatigue.
What happens if chiropractic care doesn’t help my condition?
If your condition does not improve, we’ll refer you to another trusted healthcare provider. Your health is our top priority, and we’ll ensure you get the right care.