Your costs in Original Medicare

• • $0 for covered home health care services.
  • After you meet the Part B deductible, 20% of the

Medicare-Approved Amount

•   for Medicare-covered medical equipment.

Before you start getting your home health care, we should tell you how much Medicare will pay. We 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. We should give you a notice called the Advance Beneficiary Notice” (ABN) before giving you services and supplies that Medicare doesn’t cover.

Note

If you get services from a home health agency in Florida, Illinois, Massachusetts, Michigan, or Texas, you may be affected by a Medicare demonstration program. Under this demonstration, your home health agency, or you, may submit a request for a pre-claim review of coverage for home health services to Medicare. This helps you and the home health agency know earlier in the process if Medicare is likely to cover the services. Medicare will review the information and cover the services if the services are medically necessary and meet Medicare requirements.

Your Medicare home health services benefits aren’t changing and your access to home health services shouldn’t be delayed by the pre-claim review process. For more information, call us at 1-800-MEDICARE.

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
• If 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 if, or how much, Medicare will pay for them.

Source: https://www.medicare.gov/coverage/home-health-services

Covered home health services include:

• • Medically necessary part-time or intermittent skilled nursing care
  • Physical therapy :including exercise to regain movement and strength to a body area, and training on how to use special equipment or do daily activities, like how to get in and out of a wheelchair or bathtub.
  • Occupational therapy :to help you become able to do usual daily activities by yourself. You might learn new ways to eat, put on clothes, comb your hair, and new ways to do other usual daily activities. You may continue to receive occupational therapy even if you no longer need other skilled care.
  • Speech-language pathology services
  • Medical social services: to help you with social and emotional concerns related to your illness. This might include counseling or help in finding resources in your community.
  • Part-time or intermittent home health aide care (only if you’re also getting skilled nursing care at the same time)
  • Injectable osteoporosis drugs for women
  • Durable medical equipment such as a wheelchair or walker.
  • Certain medical supplies like wound dressings, but not prescription drugs or biologicals

Usually, a home health care agency coordinates the services your doctor or allowed practitioner (including a nurse practitioner, a clinical nurse specialist, and a physician assistant) orders for you. The home health agency caring for you must be Medicare-certified.

Medicare doesn’t pay for:

• 24-hour-a-day care at your home
• Meals delivered to your home
• Homemaker services (like shopping and cleaning) that aren’t related to your care plan
• Custodial or personal care that helps you with daily living activities (like bathing, dressing, or using the bathroom), when this is the only care you need

Source: https://www.medicare.gov/coverage/home-health-services and https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/Downloads/HHQIHHBenefits.pdf

Medicare doesn’t pay for
• 24-hour a daycare at home,
• prescription drugs,
• meals delivered to your home,
• homemaker services like shopping, cleaning, and laundry, and
• personal care like bathing, using the toilet, or help in getting dressed given by home health aides when this is the only care you need.

Source: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/Downloads/HHQIHHBenefits.pdf

You have to be seen by your doctor for the past 90 days or you have a projected appointment with your MD for the next 30 days in order to start home health. This is what we call a Face to Face Encounter with your doctor. A nurse practitioner or physician assistant may perform this encounter, but the home health order must come from your physician.

On the initial visit, a registered nurse or a therapist will be doing a Comprehensive assessment. This includes a thorough interview & Evaluation for us to understand your health condition and help us. The clinician will check all your medications and assess your knowledge of taking them and the expected side effects.

Create a Plan of care specifically tailored to your needs. The assessment includes an evaluation of your medical, functional, social, And environmental needs. The staff will report the assessment to Your doctor and develop your personal care plan.

• Home Visiting Physicians (Wound Care, Internal Medicine, Family Physician, Podiatry)
• Durable Medical Equipment (DME is reusable medical equipment, like walkers, wheelchairs, or hospital beds. Anyone who has Medicare Part B (Medical Insurance) can get DME as long as the equipment is medically necessary.)
• Homemaker services
• Meals on Wheels
• Home Delivery of Medications
• Diagnostic testing at home (X-Rays, Ultrasound, EKG)
• Blood Draw (PT-INR Monitoring, and other Blood test)

We have staff that can go to the entire Chicago land area. Counties that we serve include Cook, Kane, Lake, Will, Dupage, and McHenry.

The visit frequency is individualized depending on patient needs. Generally, at the beginning of the services, the clinician usually would start with a two to three-times-a-week visit.  Until such time that you are more stable, they may decrease the visit to once a week.  It can always change and would be based on your clinical status.

You can find a Medicare-approved home health agency by looking at “Home Health Compare” at www.medicare.gov on the web.

Home Health Compare provides the:

• name and office address of the agency,
• agency phone number,
• services offered by the agency (i.e. Nursing Care, Physical Therapy, Occupational Therapy, Speech-Language Pathology, Medical/Social Services, and Home Health Aide),
• agency’s initial date of Medicare certification,
• type of ownership (For Profit, Government, Non-Profit), and
• quality measures
• Ask your doctor, hospital discharge planner, or social worker. Or, ask friends or family about their home health care experiences.
• using a senior community referral service or other community agencies that help you with your health care.

“home care” or “home health care.” (Look for home health care agencies that are Medicare-approved.)
Note: A home health agency has the right to refuse to accept any individual patient if it is unable to meet the patient’s needs.

Source: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/Downloads/HHQIHHBenefits.pdf

If your doctor decides you need home health care, you have the right to choose a home health agency to give you the care and services you need. Your choice should be honored by your doctor, hospital discharge planner, or other referring agency. Although you have a say in which agency you use, your choices may be limited by agency availability, or by Medicare’s rules. See below for Medicare’s requirements for home health agencies.

Some hospitals have their own home health agency. You don’t have to choose the hospital’s agency. You may choose any Medicare-certified agency that you feel will meet your medical needs.  If you are in a Medicare health plan, you may have to use a home health agency that works with the plan. It is important to remember that Medicare only pays for home health services that are given by a home health agency that meets Medicare’s standards and is approved (certified) by Medicare.
Medicare regularly inspects home health agencies to make sure that these standards are met. Your home health agency must provide you with all the home care identified in your plan of care, including staff services and medical supplies. The agency may do this through its own staff, an arrangement with another agency, or hiring someone else to meet your needs. This includes nurses, therapists, home health aides, and medical social service counselors.

When you start getting home care, staff from the Medicare-approved home health agency will ask you some questions about your health to help them give you proper care. The home health agency is required to keep your information confidential. You may ask to see this information. The home health agency will explain these questions and give you written information about your right to privacy.
Most Medicare-certified home health agencies will accept all Medicare patients. An agency is not required to accept a patient if it can’t meet the patient’s medical needs. An agency can’t refuse to take a specific patient because of the patient’s condition unless the agency also refuses to take other people with the same condition.