Care that comes home.

“You pay nothing for covered home health services.”

For Medicare-covered medical equipment, after the Part B deductible, “you pay 20% of the Medicare-approved amount.”

“Before you start getting your home health care, the home health agency should tell you how much Medicare will pay.”

For services Medicare may not pay for, Medicare says the agency “should give you a notice called the ‘Advance Beneficiary Notice (ABN)’ before giving you services.” If you have a Medigap policy or other insurance, “tell your doctor or other provider so your bills get paid correctly.”

We do exactly that: before the first visit, we tell you what Medicare covers and what it does not.

Medicare says you must need part-time or intermittent skilled services, and you must be “homebound.” Homebound means both of these are true:

1. “Leaving your home isn’t recommended because of your condition or you have trouble leaving your home without help (like using a cane, wheelchair, walker, or crutches; special transportation; or help from another person) because of an illness or injury.”
2. “You’re normally unable to leave your home and leaving takes a lot of effort.”

Being homebound doesn’t mean you never go out: “You may leave home for medical treatment” or for “short, infrequent absences for non-medical reasons, like attending religious services.” “You can still get home health care if you attend adult day care.”

“You won’t qualify for home health services if you need more than part-time or intermittent skilled care.”

In plain words, from us: home is where you live, including a relative’s home or a residential home for older adults; not a hospital or a skilled nursing facility. Care where you live. Eligibility is decided by your physician and our clinical team, never by this website.

1. A doctor, or a provider like a nurse practitioner, sees you in person and confirms you need home health care.
2. They order your care, and a Medicare-certified home health agency provides it. Your provider should give you a list of agencies that serve your area; the choice is yours. “Your provider must tell you if their organization has a financial interest in any agency listed.”
3. The agency schedules an appointment to talk with you about your needs and your health, and talks with your doctor about your care plan.
4. Staff visit as often as your provider orders.

For occupational therapy, your provider “must first order it along with nursing care, physical therapy, or speech-language pathology.” After that, it can continue on its own.

“Your home health agency will work with you and your doctor or allowed provider to develop your plan of care.” It says:

• “What services you need and how they’ll be provided”
• “Which health care professionals should give these services”
• “When and how often you’ll get these services”
• “The medical equipment you’ll need”
• “What results your provider expects from your treatment”

“Your provider and home health team will review your plan of care as often as necessary, but at least once every 60 days.”

How much care: “If you qualify, you can get unlimited home health visits.” Skilled nursing and aide care together can be “up to 8 hours a day (combined), for a maximum of 28 hours a week.” For a short time, your provider may approve up to 35 hours a week, if they decide it’s necessary.

By federal law, you have the right to choose your home health agency, to have your property treated with respect, to get a copy of your care plan and take part in decisions about your care, to name a family member or guardian to act for you, and to get information and services in a language you understand. The agency must give you a written copy of your rights. “You have a say in which agency you use.”

Before an agency reduces or stops services, it must give you a “Home Health Change of Care Notice” (HHCCN) “before they reduce or stop providing any home health services or supplies that change your plan of care.”

When Medicare-covered care is ending, you should “get a notice called ‘Notice of Medicare Non-Coverage’ at least 2 days before covered services end.” You can ask an independent reviewer, a BFCC-QIO, for a fast appeal “no later than noon the day before the termination date listed on the notice.”

If your Medicare comes through a Medicare Advantage plan, Medicare says to “check with your plan for more information about your home health benefits.”

If you have both Medicare and Medi-Cal, you may be in a Medi-Medi Plan. The state says: “A Medi-Medi Plan is a type of Medicare Advantage plan.” “Medi-Medi Plans coordinate all benefits and services across both programs.”

In plain words, from us: with a Medicare Advantage plan, your choice of home health agency may depend on which agencies your plan works with. Tell us your plan, and we check it with you before care starts.

Medi-Cal, California’s Medicaid program, includes both fee-for-service and managed care plans. For questions about your Medi-Cal health plan, call Health Care Options at 1-800-430-4263 (TTY 1-800-430-7077).

Free, personal help with Medicare: California’s HICAP offers “personalized health insurance counseling.” Call (800) 434-0222.

1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048): you can “talk or live chat with a real person, 24 hours a day, 7 days a week (except some federal holidays.)”

Tell us how you’re covered, and we check it with you before care starts. We never ask for an ID number on this website.