Keep Medicare Home Health Care an Age-Friendly Benefit

Last week, the Center for Medicare Advocacy laid out our Medicare Platform for the New Congress.  One of the core considerations to improve Medicare for all beneficiaries, now and in the future, is the need to reduce ongoing barriers to coverage and care. One of the key areas facing a crisis in access to Medicare coverage is home health care. We detailed this crisis in our 2018 Issue Brief Series. Going forward, the Center will push for access to Medicare-covered home care for all beneficiaries who meet coverage criteria, advance access to home health aides, and resolve conflicts between payment models and coverage laws.

Medicare-Covered Home Health Care Can Help People with Long-term Conditions
Medicare covers certain health care provided at home when an individual is unable to leave home without help and has a doctor’s order for home care that includes skilled nursing and therapy. There is no time limit to coverage as long as the individual continues to need help leaving home and needs skilled nursing or therapy. When these standards are met, Medicare also covers care provided by home health aides.

The Medicare home health benefit has been misunderstood and underutilized. People are often told Medicare will not pay if a person’s condition is not “improving.” This is not true. Medicare is available for skilled nursing and therapy intended to maintain a person’s condition, prevent deterioration, or slow decline.
The Center for Medicare Advocacy, in partnership with the John A. Hartford Foundation, is working to spread the word and help people around the Country get access to Medicare and the necessary home care they need. 
What services are covered under the Medicare home health benefit?

• Skilled nursing
• Home health aides for up to 28 hours a week combined with skilled nursing care (in some cases, up to 35 hours a week, if needed, as documented by the doctor)
• Skilled physical therapy, occupational therapy and speech language pathology services
• Medical social services
• Medical supplies

Helpful Tips:

• Family members cannot be required to help provide care in order for the patient to receive Medicare coverage.
• Home health agencies must submit a claim to Medicare upon the request of a beneficiary. A claim decision is required in order to appeal.
• A new rule prohibits agencies from discontinuing services without a doctor’s order.
• The doctor is the patient’s most important ally in obtaining and retaining home care.

The Center for Medicare Advocacy has developed numerous resources including brochures, checklists, and an infographic to help beneficiaries, and those who help beneficiaries, understand and access Medicare home health coverage. These resources are available at https://www.medicareadvocacy.org/medicare-info/home-health-care/