Home Health Services Covered by Medicare
If you’ve been following our blog, you know that Original Medicare encompasses Part A, hospital care, and Part B, doctor care. Thankfully, hospital and doctor care covered under Original Medicare is not limited to in-office care. Most of your home care needs will also be covered by your Original Medicare.
Do You Need Home Health Care?
Home health care is usually equally as effective as the care you would receive in a hospital or facility. If you have an injury or illness that prevents you from leaving your house, you’ll want to consider home health care.
Home health care is not limited to treatments and doctor visits. It can also mean care education for you and/or your caregiver. You may have a relative or friend taking care of you who needs help to give you the best care possible.
However comfortable it may be to have a friend take care of you, if you need injections or close monitoring, it may be in your best interest to hire a professional to check in on you at your home. A home nurse or doctor will also communicate with your other doctors and health care professionals to keep everyone on the same page and keep all documentation updated. It’s all in the interest of promoting good health for you.
[clickToTweet tweet=”Home health care does not only include treatments and doctor visits, but also education for you and your caregiver. ” quote=”Home health care does not only include treatments and doctor visits, but also education for you and your caregiver. “]
Home Health Services Covered By Medicare
To be eligible, you must have Medicare Part A and Part B, and a doctor must certify that you need the service that you are requesting coverage for and that you are homebound. With your Part A, you will pay $0 for home services and 20% of the Medicare price for any required medical equipment.
Included:
- Skilled nursing care
- Physical therapy
- Speech-language pathology
- Occupational therapy
Not Included:
- 24-hour home care
- Delivered meals
- Homemaker or personal services
You will stop receiving coverage for your home care if your treatment is no longer medically necessary or if you are no longer homebound.
Choosing Your Home Care
Your doctor will probably recommend a home health care service to you if he doesn’t provide those services himself. Otherwise, Medicare has a Home Health Agency finder so you can locate the care you need in your area. When choosing an agency for yourself or for a loved one, make sure you’re asking the right questions, such as:
- Are you Medicare (or Medicaid) certified?
- Do you offer ____ service?
- What are your hours and do they align with my needs?
- Will you have emergency staff available on weekends and after hours?
- Do you perform background checks on staff? Do you have credentials?
- Will I have to pay anything out of pocket?
Once you’ve narrowed your choices down, you may want to inquire about an agency’s quality of care. Any home care agency who services Medicare clients and has serviced at least 20 patients will have a star rating. Patient Care Star Ratings are based on patient health improvement and the outcome of home treatments and care.
If you have more questions about your home care costs or are considering adding coverage, like a Medicare Supplement plan to help with costs, speak to one of our agents today. Call 1-844-431-1832.
What is Medicare Fraud, Waste, and Abuse?
Medicare Fraud, Waste, and Abuse
The government loses millions each year due to Medicare fraud, waste, and abuse, causing prices to rise. Medicare fraud, waste, and abuse come from a series of laws designed to protect all parties involved in Medicare and Medicaid. The laws promote healthy relationships between agents, carriers, and clients and prevent the insurance industry from becoming profit-based, instead of care-based. Your coverage should be more important than profits.
Penalties for committing Medicare fraud can reach nearly $100,000 and result in extraction from all government health care programs.
What Is Medicare Fraud?
- Knowingly making false claims or misrepresenting data
- Knowingly giving or receiving rewards for goods and services
- Promoting one health service over another
- Billing Medicare for appointments that never happened or for more than what actually happened
What Is Medicare Waste and Abuse?
Waste and Abuse surrounds unnecessary costs or fees. Some examples are:
- Billing for unnecessary services
- Excessive supply purchases
- Misusing codes
What Are The Laws?
- False Claims Act (FCA) – Protects the government from being overcharged on goods or services. No proof of intent is required.
- Anti-Kickback Statute (AKS) – Agents cannot knowingly reward referrals for health care programs.
- Physician Self-Referral Law (Stark Law) – Doctors cannot make referrals to health care companies in which they have an interest.
- Criminal Health Care Fraud Statute – Cannot defraud; bill for unnecessary medical goods and services (like drugs that are not needed or wheelchairs for those who are not impaired).
[clickToTweet tweet=”The government loses millions each year due to Medicare fraud, waste, and abuse, causing prices to rise. ” quote=”The government loses millions each year due to Medicare fraud, waste, and abuse, causing prices to rise. “]
What Can You Do?
Don’t become a victim! If you aren’t sure about a health agent’s validity, find your agent through a field marketing organization (or FMO) like Senior Market Advisors. FMOs contract with trained, certified agents.
To help fight Medicare fraud, waste, and abuse report any suspicious activity to 1-800-HHS-TIPS (1-800-447-8477). You can also describe the incident in up to ten pages and email it to HHSTips@oig.hhs.gov.
[clickToTweet tweet=”Did you know? You can report suspicious Medicare activity to 1-800-HHS-TIPS (1-800-447-8477) or HHSTips@oig.hhs.gov.” quote=”Did you know? You can report suspicious Medicare activity to 1-800-HHS-TIPS (1-800-447-8477) or HHSTips@oig.hhs.gov.”]
Simply Explained: Medicare Savings Programs
Medicare Savings Programs
Are you eligible for a Medicare Savings Program? You could be saving hundreds each month by getting help to pay for your Medicare premiums. In some cases, these programs can even pay for other Medicare costs, including deductibles, copayments, and coinsurance.
Medicare Savings Programs, or MSPS, may sometimes be referred to as Medicare Buy-In Programs or Medicare Premium Payment Programs. Enrolling in an MSP means that you will also be automatically enrolled in the Low Income Subsidy (LIS), also called “Extra Help,” an assistance program to help you pay for Part D prescription drug costs. To qualify, you will need to already be enrolled in Original Medicare, or at least Medicare Part A.
MSPs are state Medicaid-funded, and whether or not you’re eligible for enrollment depends on your income and resource level. This is usually based on the Federal Poverty Level (FPL), but some states may have slightly different required income and resource levels.
Resources that are considered in eligibility include:
- Money in a checking or savings account
- Stocks and bonds
- Individual Retirement Accounts (IRAs)
Resources that are not considered include:
- House or car
- Burial plots
- Furniture or other personal property
Our guide will help you determine your eligibility for MSPs. But feel free to ask your agent if you still have any questions.
The are four types of Medicare Savings Programs, each with its own eligibility requirements and benefits:
- QMB (Qualified Medicare Beneficiary) Program – Pays for Part B premiums, and potentially Part A premiums, deductibles, coinsurance, and copayments as well. You may qualify if you meet these requirements:
- Single monthly income of less than $1,084
- Married monthly income of less than $1,457
- Single resources of less than $7,860
- Married resources of less than $11,800
- SLMB (Specified Low-Income Medicare Beneficiary) Program – Pays for Medicare Part B premiums. You may qualify if you meet these requirements:
- Single monthly income of less than $1,296
- Married monthly income of less than $1,744
- Single resources of less than $7,860
- Married resources of less than $11,800
- QI (Qualifying Individual) Program – Pays for Part B premiums. You must reapply every year, and the program operates on a first-come, first-serve basis with priority to renewals. You cannot enroll in the Qualifying Individual Program if you are also eligible for your state’s Medicaid program. You may qualify if you meet these requirements:
- Single income of less than $1,456
- Married income of less than $1,960
- Single resources of less than $7,860
- Married resources of less than $11,800
- QDWI (Qualified Disabled and Working Individuals) Program – Helps pay for Part A premiums. You may qualify if you meet these requirements:
- Working disabled person under 65
- Lost premium-free Part A eligibility after returning to work
- Do not receive state medical assistance
- Meet state-based income and resource limits
- Single income limit of a little over $4,000
- Married income limit of about $5,500
- Single resource limit of about $4,000
- Married resource limit of about $6,000
Still have questions? Speak with an agent today if you aren’t sure if you are eligible for a Medicare Savings Program. Just dial 1-844-431-1832 and one of our licensed agents will help you discover your options.
Updated on November 3, 2020.
