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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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NCOV -19 and MEDICARE 2020

Medicare Part B , which includes a variety of outpatient services cover medically necessary clinical diagnostic laboratory tests when a doctor or other practitioner orders them. Medically necessary clinical diagnostic laboratory tests are generally not subject to coinsurance or deductible. It will cover medically necessary imaging tests, such as computed tomography (CT) scans, as needed for treatment purposes for lung infections, however not for screening asymptomatic patients. For those imaging tests paid by Part B, beneficiary coinsurance and deductible would apply. If the Part B deductible ($198 in 2020) applies to the Part B services, beneficiaries must pay all costs - up to the approved amount of Medicare until the beneficiary meets the yearly Part B deductible. Once it is met, Medicare pays its share, and beneficiaries typically pay 20% of the approved amount of the service, except laboratory tests. There’s no yearly limit for what a beneficiary pays out-of-pocket tho

Cardiovascular Disease Risk Reduction

Cardiovascular disease generally refers to conditions that can lead to a heart attack or stroke. Cardiovascular disease risk reduction visits can help detect and prevent this disease. How to know if I am Eligible? Medicare   Part B  covers an annual cardiovascular disease risk reduction visit with your primary care  provider . You do not need to show any signs or symptoms of cardiovascular disease to qualify for screening, but you must be considered competent and alert when counseling is provided.  During the screening, your provider may; Encourage aspirin use if the benefits outweigh the risks You are a man  of age 45-79 Or a woman of age 55-79 Screen for high blood pressure if you are age 18+ Provide behavioral counseling and tips to encourage a healthy diet Note: Men under 45 and women under 55 are not encouraged to use aspirin as a tool to reduce cardiovascular disease. How much will it cost? If you are eligible,  Original Medicare  will cover your cardiovascular disease risk red

Lifetime Reserve Days

There are  90 days of  inpatient  hospital care coverage on Original Medicare for each  benefit period , In addition, you also have an additional 60 days of coverag e , called LIFETIME RESERVE DAYS .   These Lifetime Reserved Days  can be used only ONCE, and you will pay a  coinsurance  for each of it. To have a better understanding of it, let’s imagine an individual who had a 120-day  Medicare -covered inpatient stay, this means that they used 30 lifetime reserve days. After they have been out of the hospital for 60 days in a row, they will be eligible for another 90 days of hospital coverage because they will be in a new  benefit period . However, if they need  inpatient care  beyond the benefit period maximum, they will only have 30 of their 60 lifetime reserve days remaining. The above example illustrates that lifetime reserve days do not have to be applied to the same hospital stay. If you need to stay in the hospital twice for 120 days each time during different benefit