More Information about Home Health Care

Home health care for Chronic Condition

Once you meet Medicare’s home health eligibility requirements, Medicare will cover your care regardless of whether your condition is temporary or chronic.

Medicare covers skilled nursing and therapy services as long as they:

Help you maintain your ability to function
Help you regain function or improve
Or, prevent or slow the worsening of your condition

Providers and agencies may worry that Medicare will not cover skilled home care if you are no longer showing signs of improvement. However, Medicare will not deny your home care because your condition is chronic or unchanging, or when additional care will not improve your ability to function, as long as the care is medically necessary to maintain your condition or to prevent or slow deterioration.

If you have chronic care needs, it may be hard to find a home health agency (HHA) willing to provide you with services. If you have Original Medicare, call 1-800-MEDICARE for a list of HHAs in your area. If you have a Medicare Advantage Plan, contact your plan for a list of in-

network HHAs.

HOW TO START HOME HEALTH CARE

The process for starting the Medicare home health benefit changes depending on whether you are currently in a hospital or if you are already at home. Remember, in both cases, you must meet the eligibility requirements and qualify for coverage under either Part A or Part B.

Hospitalized: A hospital social worker or discharge planner should arrange for a Medicare-certified home health agency (HHA) to visit you and assess your condition. If you qualify, you should receive home health care after being discharged.
At home: Speak to your doctor about your home health needs and ask for a list of Medicare-certified HHAs. You, your doctor, or a caregiver should be able to call an HHA directly and ask them to visit your home and assess your condition. You should also be able to find local HHAs through your hospital discharge planning office, 1-800-MEDICARE, or the Eldercare Locator.

In either situation, the HHA should evaluate your home health needs and create a plan of care. Your doctor must certify that you qualify for Medicare’s home health benefit, sign off on the plan of care, and recertify the plan every 60 days.

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Medicare Part D Costs for 2020

Before 2006, Medicare did not cover prescription medications. There was a limited number of medications that were offered under Medicare Part Band, and otherwise, you had to pay for your medications out of pocket. In 2003, everything had changed when President George W. Bush passed the Medicare Prescription Drug, Improvement, and Modernization Act (MMA). This is what we now know of as Medicare Part D , an optional part of Medicare that provides prescription drug coverage. Part D plans are run by private insurance companies and not by the government. However, the federal government sets guidelines on what basic medications are covered and how much you can be charged. A deductible is the amount of money you spend out of pocket before your prescription drug benefits begin. Your plan may or may not have a deductible. The maximum deductible a plan can charge for 2020 is set at $435. It has increased by $20 from 2019. Part D

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Benefit Period

The benefit period is the length of time during which a benefit is paid. It measures your use of inpatient hospital and skilled nursing facility (SNF) services. This begins the day you are admitted as an inpatient, or to an SNF, and ends the day you have been out of the hospital or SNF for 60 days in a row. After you meet your deductible , Original Medicare will pay in full for days 1 to 60 that you are in a hospital. The remaining days, 61-90 , you will have to pay a daily coinsurance. If your 90 days of hospital coverage has been consumed but you need to stay longer, Medicare covers up to 60 additional lifetime reserve days and yo u will also have to pay a daily coinsurance . These days are nonrenewable , meaning you will not get them back when you become eligible for another benefit period. If you run out of days during your benefit period, Medicare will stop paying for your in-patient related hospital costs such as room and board. To be eligible for a new b

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Comparing Health Care Providers

How do I compare the quality fo Health Care Providers? Medicare collects information about the quality and safety of medical care and services given by most health care providers (and facilities). Check Medicare.gov/quality-care-finder and get a snapshot of the quality of care they give their patients. Some feature a star rating system to help you compare quality measures that are important to you. Find out more by: Talking to your health care provider. Each health care provider should have someone you can talk to about quality. Asking your doctor or other health care provider what he or she thinks about the quality of care other providers give. You can also ask your doctor or other health care provider about the quality of care information you find on Medicare.gov . Having access to quality and cost information upfront helps you get a complete picture of your health care options. You'll be able to compare quality ratings, cost information, and other details to hel

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