Medicare Coverage

Patients Have Rights to Choose Their Home Health Care Agency

As just as our “right to vote” is fundamental to a better government, so is our “right to choose” a fundamental requirement for a better healthcare system. Medicare has reserved this “right of choice” for beneficiaries because they know a competitive environment improves outcomes and keeps costs lower for the patients they serve. Unfortunately, too many people do not exercise their rights, and, in many cases, they are left with inferior service. Because many patients may require long-term services from a home health agency, you should be an active participant in deciding which agency will serve you.

It is important to understand that Medicare sets the prices paid for services received by their beneficiaries. Since the prices are set by Medicare, the real difference in value comes from the services and attention you get from the home health agency serving you. Some agencies employ various tactics to maximize patient volume and profits, while others focus on trying to provide the highest level of service for the reimbursement allowed by Medicare. In either case, your choice of home health providers will influence your outcomes. Since Medicare pays the bill (for Medicare beneficiaries) and you receive the services, your doctor or case manager may have no way to determine if the services you receive are the best you can get.

senior home care centerMedicare Coverage

Senior home cares understand that determining what services Medicare will cover can be challenging and overwhelming. The good news is Medicare provides 100% of coverage for home health care with no co-pays as long as the eligibility requirements are met.

Many senior home care has Home Care Specialists available to answer additional questions regarding Medicare coverage and their home care options. Do your own research of senior home care center near you.

Please note: Medicare does not cover private care (also known as private pay home care) services such as personal care attendants or companion care aides, but some elderly care home provides these services on an affordable private-pay basis.

*Social Security Act, 1802(a): “Basic freedom of choice. —Any individual entitled to insurance benefits under this title may obtain health services from any institution, agency, or person qualified to participate under this title if such institution, agency, or person undertakes to provide him such services.

elderly care homeWho is Eligible for Medicare Covered Home Health Services?

As a Medicare beneficiary enrolled in Part A, Part B or both, you are eligible to receive Home Health Services 100% covered by Medicare with no Co-payments if you meet the following conditions:

Under a physician’s care and physician must approve home health care.

Medicare Homebound Determination:

  • A normal inability exists; to leave home would require considerable and taxing effort.
  • If the patient leaves home, he/she requires assistance of another person or an “assistive” device such as a walker, cane or wheelchair.
  • The absences from the home are infrequent or for short duration, or are attribute to the need to receive health care treatment.
  • A patient’s homebound status is not violated by attendance of religious services or attendance at a State licensed, medical adult day care center.