Helping Hands of Yuma

March 2018 – Home Health Care – Being in the Know

Home health services

This month we will highlight information about Home Health Services and how it affects you as recipient. Please make sure you have a thorough conversation with your physician when he/she indicates that you need home health care for a period of time. It is important that you understand every aspect including what Home Health Care can and cannot provide to you.

How often is Home Health Care covered?

Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance) covers eligible home health services like these:

Usually, a home health care agency coordinates the services your doctor orders for you.

Medicare doesn’t pay for:

Who’s eligible?

All people with Part A and/or Part B who meet all of these conditions are covered:

  • You must be under the care of a doctor, and you must be getting services under a plan of care created and reviewed regularly by a doctor.
  • You must need, and a doctor must certify that you need, one or more of these:
  • Intermittent skilled nursing care (other than drawing blood)
  • Physical therapy, speech-language pathology, or continued occupational therapy services. These services are covered only when the services are specific, safe and an effective treatment for your condition. The amount, frequency and time period of the services needs to be reasonable, and they need to be complex or only qualified therapists can do them safely and effectively. To be eligible, either: 1) your condition must be expected to improve in a reasonable and generally predictable period of time, or 2) you need a skilled therapist to safely and effectively make a maintenance program for your condition, or 3) you need a skilled therapist to safely and effectively do maintenance therapy for your condition.The home health agency caring for you is approved by Medicare (Medicare certified).
  • You must be homebound, and a doctor must certify that you’re homebound.

You’re not eligible for the home health benefit if you need more than part-time or “intermittent” skilled nursing care.

You may leave home for medical treatment or short, infrequent absences for non-medical reasons, like attending religious services. You can still get home health care if you attend adult day care.

Note

Home health services may also include medical social services, part-time or intermittent home health aide services, medical supplies for use at home, durable medical equipment, or injectable osteoporosis drugs.

Your costs in Original Medicare

Before you start getting your home health care, the home health agency should tell you how much Medicare will pay. The agency should also tell you if any items or services they give you aren’t covered by Medicare, and how much you’ll have to pay for them. This should be explained by both talking with you and in writing. The home health agency should give you a notice called the “Home Health Advance Beneficiary Notice” (HHABN) before giving you services and supplies that Medicare doesn’t cover.

Note

To find out how much your test, item, or service will cost, talk to your doctor or health care provider. The specific amount you’ll owe may depend on several things, like:

  • Other insurance you may have
  • How much your doctor charges
  • Whether your doctor accepts assignment
  • The type of facility
  • Where you get your test, item, or service

Note

Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. Ask questions so you understand why your doctor is recommending certain services and whether Medicare will pay for them.

For more information and details regarding Home Health Care, please contact your physician’s office or go to https://www.medicare.gov/coverage/home-health-services.html.

Senior Connect