Department of
Insurance

Medicare Home Health Care and Hospice Benefits

What is Home Health Care?

Home Health Care is skilled nursing care and certain other health care services that you get in your home for the treatment of an illness or injury.

How Can I Get Care at Home?

To get Medicare home health care:

1. Your doctor must decide that you need medical care in your home, and make a plan for your care at home; and
2. You must need at least one of the following: intermittent (and not full time) skilled nursing care, or physical therapy or speech language pathology services; and
3. You must be homebound. This means that you are normally unable to leave home. Being homebound means that leaving home is a major effort. When you leave home, it must be infrequent, for a short time, or to get medical care, attend adult day care, religious services; and
4. The home health agency caring for you must be approved by the Medicare program.

The Original Medicare Plan covers these home health care services:

Medicare Services	Covered
Part-Time or Intermittent Skilled Nursing Care	x
Part-Time or Intermittent Home Health Aide Services	x
Physical and Occupational Therapy	x
Speech Language Pathology Services	x
Medical Social Services	x
Medical Supplies (not drugs or biologicals)	x
Durable Medical Equipment	x*

*The Original Medicare Plan usually pays 80% of the approved amount for certain pieces of medical equipment. You may have to pay 20% of the approved amount for durable medical equipment. Ask your supplier "Do you accept assignment?" Assignment could save you money.

How Do I Find an Approved Home Health Agency?

It is important to remember that Medicare only pays for home health services that are given by a home health agency that meets Medicare's quality standards and is approved by Medicare. Medicare regularly inspects home health agencies to make sure that these standards are met. You can find a Medicare-approved home health agency by:

• asking your doctor or hospital discharge planner
• using a senior community referral service, or other community agencies who help you with your health care
• looking in your telephone directory in the Yellow Pages under "home care" or "home health care." (Look for home health care agencies that say they are Medicare approved.)

What if I am in a Medicare Advantage Plan?

It is very important to remember: If you belong to a Medicare Advantage plan, your choice of home health agencies may be limited to agencies that contract with or agree to accept the Medicare Advantage plan. Call your plan if you have questions about the plan's home health care rules. If you get services from a doctor or a home health care agency that doesn't work with the  plan, neither the plan nor Medicare will pay the bill.

What is hospice?

Hospice is a special way of caring for people who are terminally ill, and for their family. This care includes physical care and counseling. Hospice care is given by a public agency or private company approved by Medicare. It is for all age groups, including children, adults, and the elderly during their final stages of life. The goal of hospice is to care for you and your family, not to cure your illness.

In many cases, you and your family can stay together in the comfort of your home. Depending on your condition, you may have hospice care in a hospice facility, hospital, or nursing home.

Who is eligible for Medicare hospice benefits?

Hospice care is covered under Medicare Part A (hospital insurance). You are eligible for Medicare hospice benefits when:

• You are eligible for Medicare Part A (hospital insurance); and
• Your doctor and the hospice medical director certify that you are terminally ill and probably have less than six months to live; and
• You sign a statement choosing hospice care instead of routine Medicare covered benefits for your terminal illness*; and
• You receive care from a Medicare-approved hospice program.

*Medicare will still pay for covered benefits for any health problems that are not related to your terminal illness.

What does Medicare cover?

Medicare covers these hospice services and pays nearly all of their costs:

Medicare Services	Covered
Doctor services	x
Nursing care	x
Medical equipment (such as wheelchairs or walkers)	x
Medical supplies (such as bandages and catheters)	x
Drugs for symptom control and pain relief	x
Short-term care in the hospital, including respite care (see below)	x
Home health aide and homemaker services	x
Physical and occupational therapy	x
Speech therapy	x
Social worker services	x
Dietary counseling	x
Counseling to help you and your family with grief and loss	x

What will I have to pay for hospice care?

Medicare pays the hospice for your hospice care. You will have to pay:

• No more than $5 for each prescription drug and other similar products: The hospice can charge up to $5 for each prescription for outpatient drugs or other similar products for pain relief and symptom control.
• 5% of the Medicare payment amount for inpatient respite care: For example, if Medicare pays $100 per day for inpatient respite care, you will pay $5 per day. You can stay in a Medicare-approved hospital or nursing home up to 5 days each time you get respite care. There is no limit to the number of times you can get respite care. The amount you pay for respite care can change each year.

Can I keep my Medicare insurance plan?

Yes. You should use your Medicare supplement insurance or health plan to get care for any health problems that are not related to your terminal illness.

How long can I get hospice care?

You can get hospice care as long as your doctor certifies that you are terminally ill and probably have less than six months to live. Even if you live longer than six months, you can get hospice care as long as your doctor recertifies that you are terminally ill.

Hospice care is given in periods of care. As a hospice patient, you can get hospice care for two 90-day periods followed by an unlimited number of 60-day periods. At the start of each period of care, your doctor must certify that you are terminally ill in order for you to continue getting hospice care. A period of care starts the day you begin to get hospice care. It ends when your 90 or 60-day period is up. If -your doctor recertifies that you are terminally ill, your care continues through another period of care.