Medicare is mandated to cover your home health benefits with no limit on the time you are covered. Unfortunately, few Medicare beneficiaries get the level of service they are entitled to, and many find their services cut off prematurely. Getting these benefits can be critically important as Medicare home health care benefits can mean the difference between being able to stay at home with a difficult medical problem or ending up in the hospital or a nursing home.
As a Medicare recipient, you are entitled to full home health benefits if you meet the following requirements:
- You must be confined to your home (i.e., leaving your home to receive services would be a “considerable and taxing effort”);
- Your doctor must have ordered home health services for you;
- At least some element of the services must be skilled, skilled nursing care, physical therapy, or speech therapy (which will also entitle you to Medicare coverage of social services and home health aide services); and
- You must receive the services from a certified home health agency.
Under the law, you are entitled to 35 hours of service a week, but few Medicare beneficiaries who meet the home health care criteria actually get this level of service. If your services are terminated prematurely, you will need to appeal.
If you can, you should continue to pay privately for care during the appeals process. Remember, the issue you are appealing is not the termination of service, but the denial of Medicare payment for the service.
In order to mount a successful campaign to get your services back, you should:
- Ask your home health agency to explain the cutback and write the information down;
- Ask your physician to call the agency urging them not to cut back the services and have the physician send a letter detailing the level of care you need; and
- Immediately consult with your attorney to determine the likelihood of a successful appeal.