Friday, July 12, 2024

Does Medicare Part B Cover Home Health Care Services

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Home Health Care Services Under Medicare Part A: Video 6

Many Medicare enrollees are qualify for Medicaid due to their limited incomes and assets. Unlike Medicare, Medicaid covers both nursing home care and Home and Community Based Services .

Due to the high cost of long-term care, many states have higher Medicaid income limits for long-term care benefits than for other Medicaid coverage. However, Medicaids asset limits usually require you to spend-down resources before becoming eligible.

How Can I Qualify For Medicare Home Health Care

Home health care is designed for people who cant make it to the doctor very often because theyre homebound. That means your regular doctor must certify that you have difficulty leaving home. Your doctor must also confirm that you need one or more of the covered services listed above.

Medicare home health care coverage may not be enough for people who need long-term care at home. If you require home health care for more than eight hours a day or for seven days per week, youll have to pay out of pocket.

To receive Medicare home health care coverage, you must have both Part A and Part B. If you dont have them, find out if youre eligible for Medicare.

If you have Medicare Advantage, youll receive the same home health care coverage that Parts A and B pay for. You may also receive other benefits such as Medicare prescription drug coverage and dental care. Learn more about Medicare Advantage plans.

What Is Home Health Care

Home health care covers a wide range of health services administered in your home following an injury or illness. For many, it is an ideal solution as it is cost-effective, convenient, and just as effective as the care that you would receive in a hospital or clinic.

Sometimes called home-care, supportive care, or in-home care, home health care is provided by a qualified professional in your own home, rather than in a clinic or other group accommodation.

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How Much Does Medicare Cover For Home Health Care

If you have original Medicare, you dont pay anything for home health services. There is a co-pay of 20% of the Medicare-approved amount for durable medical equipment .

Before starting with home health care, you should be advised by your agency on what costs will be incurred and which are covered by Medicare. They will also inform you of any services that arent covered by Medicare. This should be communicated in-person and in writing and you will also be provided with an Advance Beneficiary Notice before any non-Medicare services are provided.

In some states your home health agency may submit a pre-claim review request to Medicare. This helps you and the agency as you know whether Medicare is likely to cover the services.

The specific amount you owe for non-Medicare covered services will depend on:

  • Any other medical insurance you have
  • Your doctors rates
  • If your doctor accepts assignment
  • The type of treatment facility
  • Where you get your tests or services.

In some cases, your doctor may recommend a treatment plan that requires more regular treatments than are covered by Medicare, or they may recommend services that are not covered. If this happens, you will be liable for the costs, so it is important to ask questions so that you know why they are being recommended, and what costs you will need to pay out-of-pocket.

How Does A Medigap Plan Work With Medicare Part B

Armor Medicare

If you are signing up for a Medigap plan to go with your traditional Medicare Part A and B, you may be wondering how the plans will work together.

First and foremost, it is important to understand that Medicare is your primary coverage. The Medigap plan acts as a secondary coverage to regular Medicare.

A Medigap plan can be used anywhere that Medicare is accepted regardless of what Medigap company you use. Medigap plans are non-network plans, so if a doctor takes Medicare , they will also take the Medigap plan. Medigap claims are handled through the Medicare crossover system.

As far as coverage, Medigap plans are designed to fill in the gaps in regular Medicare, including Medicare Part B. Medicare Part B generally pays 80% after the Part B deductible, and the Medigap plans pay the remaining 20% with some plans also picking up that Part B deductible.

If you have other questions or wish to speak to someone directly, you can contact us online or call us at 877.506.3378.

Get a List of Medigap Plans via Email

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Pros And Cons Of Home Health Care

The benefits of properly administered home health care can be enormous. The fact that Medicare will pay for an unlimited number of home health care visits with no copayments makes home care a very good financial value compared to recovery in a hospital or nursing facilityin addition to the recuperative benefits of being at home.

Being in your own home or even that of a friend or relative is often more conducive to a speedy recovery than the impersonal and sometimes frightening environment of a hospital. You have familiar things around you, your friends and family can come and go without worrying about “visiting hours,” and they can lend a hand with your care. You have greater privacy and are free from dreadful hospital routines and late-night noise and lights.

On the other hand, home health care is not always the best solution. Hospitals sometimes push people out the door before they are well or strong enough, and as a result the people may take longer to recover at home, or suffer more pain and discomfort at home, than they would have if they had remained in the hospital just a few days more. This is particularly true when a patient does not have family or friends available to supplement the care provided by a home care agency.

When To Enroll In Medicare Part B

The periods to enroll in Medicare Parts A or B are the same. You are eligible to enroll in Medicare Part B if you are a US citizen who is 65 or older. If you meet these requirements, you can first sign up during the 7-month Initial Enrollment Period. For most people, this begins three months before their 65th birthday and ends three months after.

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If youre receiving retirement benefits, you dont need to worry about signing up you will automatically be enrolled in Medicare Parts A and B when you turn 65.

If you miss the initial enrollment period and havent begun collecting retirement benefits , you can enroll in Medicare Part B during the General Enrollment Period. This period begins at the start of every calendar year and continues for three months .

Agent Tip

If you dont enroll in Medicare Part B on time, you can be subject to a life-long penalty. If you are unsure if you should sign up you give us a call at .

Finally, some people can sign up for Part B during a Special Enrollment Period . SEPs provide a way for people covered under a group health plan to sign up for Part B. However, even if you do have a group health plan, youre only eligible if youre working or have finished work within the last eight months.

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Does Humana Cover Home Health Care

  • Some Humana Medicare Advantage plans can cover home health care services such as care managers, home meal delivery, medical transportation, prescription drug deliver, caregiver support and more. Learn more and find a Humana Medicare plan that offers the home health benefits you need.

Many Humana Medicare Advantage plans may cover home health care and other benefits designed to help seniors age in place at home. Plan benefits and availability can vary, so its a good idea to compare plan details online or call to speak with a licensed insurance agent who can help you find out what benefits are offered by Humana Medicare plans available where you live.

Many Medicare beneficiaries who choose to enroll in a Medicare Advantage plan typically might do so because of the extra benefits that many of these plans may offer that are not included in Original Medicare .

Some Humana Medicare Advantage plans may cover home health care along with prescription drugs, dental, vision, hearing, transportation, home meal delivery and more, all of which arent available with Original Medicare coverage.

When You Need Part

What Health Care Services Are Covered by Medicare?

Updated By Bethany K. Laurence, Attorney

Progressive health care professionals often encourage people to get out of hospitals and nursing facilities and into their own or family members’ homes while recovering from injury or illness. With less honorable motives, insurance companies also pressure hospitals to release patients earlier so that if they continue to receive care, it will be a less costly variety at home.

In response to both these movements, many new home health care agencies have sprung up. You’re increasingly likely to find such an agency in your local area. Most are able to provide care for patients who no longer need high-level care in a hospital but who still require part-time nursing or rehabilitative therapy.

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How Much Does Home Health Care Cost With Medicare

Even if your home health care services are covered by Medicare, you may have to pay some money out of pocket.

Typically, youll pay $0 for Medicare-covered home health care services and 20% of the Medicare approved amount for durable medical equipment .

Ask your home health agency how much Medicare will pay before you begin receiving home health care. This can help prevent you from being surprised by unexpected out-of-pocket costs.

What If Medicare Won’t Cover All My Physical Therapy

Medicare no longer caps how much medically necessary physical therapy it will cover throughout the year. But in some cases, doctors might recommend physical therapy beyond what Medicare considers medically necessary. In this case, you may be stuck paying for additional treatment sessions out of your own pocket.

To help pay these costs, you could turn to Medicaid, which helps some low-income people, pregnant women, and families cover their health care costs.

Otherwise, consider switching from Original Medicare to Medicare Advantage. Many Medicare Advantage plans cover more services than Original Medicare, so you could find a plan that pays for more physical therapy.

Learn more about the differences between Original Medicare and Medicare Advantage.

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What Does Medicare Cover For Home Health Care In The Us

If youre looking for an answer to the question, what does Medicare cover for home health care in America?, youve probably typed it into google and immediately closed the tab. The volume of information and the level of detail can quickly become confusing and overwhelming . Weve broken this important query down into a series of frequently asked questions, looking at what home health services are available, what services arent covered, who is eligible, and what costs you can expect to incur.

How Long Does Medicare Pay For Home Health Care

Medicare Part B â Medical Insurance

Youve just found out that Medicare will pay for many of the home health care services your senior needs. Thats great news! The question now becomes, how long will that care last?If youre looking for care for your senior that is provided 24/7 around the clock, youll have to consider a nursing home or another option. Medicare doesnt provide coverage for such care.Instead, they emphasize that the care that is required must be intermittent. In other words, the senior either needs Fewer than 7 days of care each week or need daily care for less than 8 hours each day for up to 21 days.Additionally, Medicare also notes that it may extend the three week limit in exceptional circumstances if your doctor can predict when your need for daily skilled nursing care will end.

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Home Health Change Of Care Notice

The home health agency must also give you an ABN or a HHCCN when they reduce or stop providing home health services or supplies because of one of these:

  • The home health agency makes a business decision to reduce or stop giving you some or all of your home health services or supplies.
  • Your doctor changed your orders, which may reduce or stop giving you certain home health services or supplies that Medicare covers.

The HHCCN lists the services or supplies that will be changed, and it gives you instructions on what you can do if you dont agree with the change.

The home health agency isnt required to give you a HHCCN when it issues the Notice of Medicare Non-coverage .

Medicare And Home Health Care

If you need skilled nursing care, some kinds of therapy, hospice, or other services in your home, Medicare may cover those home health services. If you need custodial care, however, Medicare probably won’t pay for it.

Read on to find out how much Medicare will pay for, how to qualify for home health care coverage, and what to do if the services you need aren’t covered.

Call a Licensed Agent:

Home health care could be a key part of social distancing for Medicare beneficiaries. Receiving medical care at home can prevent the spread of coronavirus and free up hospital bed for critical patients.

Ask your home health care provider about the precautions their workers are taking to guard against COVID-19 and protect their workers and patients.

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What Durable Medical Equipment Is Covered By Medicare

The cost of durable medical equipment is covered by Medicare if it is deemed medically necessary, and has been prescribed by a doctor for use at home. The list of covered durable medical equipment includes:

  • Wheelchairs
  • Nebulizers
  • Blood sugar monitors.

You will pay 20% of the Medicare-approved amount for the equipment, and you will be liable for any remaining deductible under Medicare Part B.

Who Qualifies For Home Health Care With Medicare

Medicare Home Healthcare Coverage – Medicare Explained: Home Health Services Covered by Medicare

Medicare has several conditions in place for home health care. Anyone with Part A or Part B coverage who meets all of these qualifying factors is eligible:

  • You must have a doctor overseeing your care, and they must regularly review your care.
  • Your doctor must certify that you need intermittent skilled nursing care and/or therapy services
  • Your doctor must certify that you are homebound.
  • A Medicare-certified agency must provide your care.
  • You must meet face to face with your doctor or health care professionals who work with a doctor within the required time frames about your need for home health care.

Even when deemed homebound, you are still able to leave for medical treatment or for a short, infrequent nonmedical reason, such as a haircut, a religious service, or attending a funeral or family reunion.

Notice that you must seek care from Medicare-certified agencies. These agencies have agreed to be paid by Medicare and to accept only the Medicare-approved amount for their services. They cannot engage in balance billing. By using an approved agency, youll reduce your out-of-pocket costs.

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Advance Beneficiary Notice Of Noncoverage

When the home health agency believes that Medicare may not pay for some or all of your home health care, the agency must give you an ABN.

Home health agencies are required to give you an ABN before you get any items or services that Medicare may not pay for because of any of these reasons:

  • Theyre not considered medically reasonable and necessary.
  • The care is only nonskilled, personal care, like help with bathing or dressing.
  • You arent homebound.
  • You dont need skilled care on an intermittent basis.

When you get an ABN because Medicare isnt expected to pay for a medical service or supply, the notice should describe the service and/or supply and explain why Medicare probably won’t pay.

The ABN gives clear directions for getting an official decision from Medicare about payment for home health services and supplies and for filing an appeal if Medicare wont pay.

Do Medicare Advantage Plans Cover Home Health Care

Very recently, advantage plans are allowing coverage for a range of in-home care services. Although only 3% of policies offer in-home support like personal care and housekeeping.

However, new supplemental benefits are now an option, just on a bigger scale. About 13% of plans cover family caregiver support like respite care and counseling.

Times are changing, and in-home care is necessary for many seniors in the U.S. As the baby boomer population grows into retirement, more people need in-home care.

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What Medicare Will Not Cover

Medicare will not pay for a number of services sometimes provided as part of home health care, including:

  • drugs and biologicals administered at home
  • personal care by part-time home health aides if this is the only care you need
  • meals delivered to your home
  • housekeeping services, or
  • full-time nursing care.

If you require durable medical equipment, such as a special bed or wheelchair, as part of your home care, Medicare will pay only 80% of the costs.

For more information on Medicare coverage of home health care, read Medicare’s online publication Medicare and Home Health Care at .

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