Part A covers inpatient hospitalizations, care in skilled nursing facilities, palliative care, and some home health care. Home health care includes a wide range of health and social services provided at home to treat illnesses or injuries. Before you start getting home health care, the home health agency must tell you how much Medicare will pay. Prior to this, beneficiaries who were only enrolled in Part A could receive up to 100 home health care visits per benefit period during the year following a three-day hospital stay. The costs and benefits may be different for beneficiaries enrolled in Medicare Advantage plans, so check with your plan to find out how they provide home health benefits covered by Medicare.
Under Medicare Part B, you are eligible for home health care if you are homebound and need specialized care even if you haven't been hospitalized before. The agency must also let you know (both verbally and in writing) if Medicare won't pay for the items or services it provides and how much you'll have to pay for them. The Center for Medicare Advocacy will continue to refute this fiction and advocate for beneficiaries who need and qualify for long-term Medicare coverage and home health care. You can still leave home for special occasions outside of health care, such as religious services, family reunions, funerals, occasional trips to the hair salon or beauty salon, etc.
Ask the home health agency what services Medicare will pay for and which are not covered, as some agencies may recommend services that Medicare doesn't cover. In most cases, part-time or intermittent services mean that you may be able to receive skilled nursing care and ancillary home health services for up to 8 hours a day (combined), for up to 28 hours per week. The agencies that offer these services are called home care agencies and should not be confused with home health agencies that offer home health care services. You won't qualify for the home health care benefit if you need more than intermittent or part-time specialized care.
While it can be implemented this way, under the law, people who meet the minimum requirements (legally confined to their home and who need specialized care) are eligible for Medicare home health coverage whenever they need specialized care. The relevant legislative background of OBRA 1980 makes it clear that Congress intended to “liberalize” the provision of Medicare home health care, and that the changes consisted of “increasing benefits” that were important to beneficiaries. By virtue of this demonstration, your home health agency can submit to Medicare a request for a review prior to the application for coverage of home health services.
