Marci’s Medicare Answers: August 2014
I have Original Medicare. What requirements do I have to meet in order for Medicare to cover home health care?
Medicare will pay for home health care if you meet all of the following requirements:
- You must be homebound. Medicare considers you to be homebound if you need the help of another person or special equipment to leave your home or your doctor believes that leaving your home would be harmful to your health. In addition, it must be difficult for you to leave your home.
- You must need skilled nursing care on an intermittent basis or skilled therapy services. This means that you must need care as a little as once every 60 days to as much as once a day for three weeks. Note that skilled care is care that can only be safely administered by a licensed nurse or therapist. Also note that you will not qualify for Medicare coverage of home health care if you only need occupational therapy.
- You must have a face-to-face visit with a health care professional within 90 days of starting to receive home health care or 30 days after you have started to receive care. Your doctor must sign a home health certification, verifying that you have had this visit and that you qualify for home care because you are homebound and need skilled care.
- You must receive certified care from a Medicare-certified home health agency (HHA).
Keep in mind that your doctor will need to approve your plan of care every 60 days. As long as you continue to meet Medicare coverage rules, Medicare should continue to cover your home health care. If you have Original Medicare, the traditional Medicare program administered directly through the federal government, and you have questions about Medicare coverage of home health care, you can contact 800-MEDICARE or go online and visit www.medicare.gov.
My local senior center recently provided some of us with a presentation on Medicare fraud and abuse. What can I do help prevent Medicare fraud and abuse?
Medicare fraud occurs when health care providers bill Medicare for health care services you never received. Medicare abuse occurs when health care providers do not follow good medical practices, leading to unnecessary Medicare costs and improper payments made to providers. Medicare fraud, waste and abuse cost the federal government millions of dollars each year.
It is important for people with Medicare, caregivers and professionals to be on the lookout for Medicare fraud, waste and abuse. There are several things you can do to help prevent Medicare fraud:
- Protect your Medicare number and Social Security number. Only give this information out to health care providers and individuals you trust.
- Do not share your medical information with people who are not health care professionals and people you do not know.
- Know what health care services are covered by Medicare. If you get your Medicare benefits through Original Medicare, the traditional Medicare program administered directly through the federal government, you can contact 800-MEDICARE or go online and visit www.medicare.gov to learn more about what health care services Medicare will cover. If you get your Medicare benefits through a Medicare Advantage plan, also known as a Medicare private health plan, you should contact your plan directly to learn more about your plan benefits.
- Be wary of health care providers who promise you that Medicare will pay for treatments that are not medically necessary. In general, Medicare only covers care that is considered to be medically necessary.
- Don’t accept services you feel you don’t need. Be wary of health care providers who try to pressure or scare you into getting tests, exams or expensive procedures that you feel are not medically necessary.