Health Column: Requirements for home health care

Dear Marci,
I need home health care. Will Medicare cover this?

Dear Boris,
Medicare will help pay for your home care if all of the following are true:
• You are housebound, meaning it takes a considerable and taxing effort to leave your home.
• You need skilled nursing care on a part-time or intermittent basis and/or you need skilled therapy services.
• Your doctor signs a home health certification stating that you qualify for Medicare home care because you are housebound and need intermittent skilled care. The certification must also say that a plan of care has been made for you, and that it’s regularly reviewed by a doctor. Usually, the certification and plan of care are combined in one form that is signed by your doctor and submitted to Medicare.

Starting April 1, as part of the certification, doctors must also confirm that they (or certain other providers, such as nurse practitioners) have had a face-to-face meeting with you that was related to the main reason you need home care. This meeting must occur within 90 days of starting to receive home health care or within 30 days after you have already started receiving home health care. Your doctor must specifically state that the face-to-face meeting confirmed that you are housebound and that you qualify for intermittent skilled care.
You must receive your care from a Medicare-certified home health agency.

Dear Marci,
I have retiree benefits and I just became eligible for Medicare. Do I still need Medicare Part A and Part B?

Dear Lakshmi,
Usually, yes. Once you become eligible for Medicare, insurance you get from a past job (“retiree insurance”) always pays after Medicare. Many retiree policies require you to sign up for Medicare Parts A and B. These policies may help pay for Medicare costs or for things Medicare does not cover. That means you need to enroll in Medicare Part A and Part B so that you will have full insurance coverage.

Some exceptions are if you have end-stage renal disease or you have health insurance from an HMO under the Federal Employees Health Benefit Program. That coverage may be comprehensive enough that you won’t need to sign up for Medicare Part B coverage.

Some employers sponsor Medicare private health plans (Medicare Advantage), such as Medicare HMOs and PFFS plans, for retirees who are eligible for Medicare. If you worked for one of these employers, you can get both your Medicare benefits and your retiree health benefits by signing up for a Medicare private health plan that has a contract with your former employer. Some employers require that you join a Medicare private health plan to continue getting retiree health benefits. You can always choose not to take your employer’s coverage and sign up for Original Medicare or a Medicare private health plan that isn’t sponsored by your employer. However, keep in mind that you may not be able to get that retiree coverage if you want it at a later date.

Call your employee benefits office to find out how your retiree policy works with Medicare. Determine whether it pays no matter which doctors you use (or only if you use HMO doctors), and check to see whether you can get it back if you drop it or buy other insurance.

Dear Marci,
I have Extra Help, and I heard I can change drug plans at any time. Is that true?

Dear Barbara,
Yes. If you receive Extra Help, the federal program that helps pay for the Medicare drug benefit, you get a Special Enrollment Period (SEP) that allows you to join, disenroll from or switch Medicare drug plans on a monthly basis. The SEP begins the month that you become eligible for Extra Help, Medicaid or a Medicare Savings Program (MSP), and continues as long as you have Extra Help. (If you lose Medicaid or MSP, or if you lose Extra Help during the calendar year, you get one two-month SEP. If you lose Extra Help for the next calendar year because you are no longer deemed eligible, you get one SEP that lasts from January to March.

To switch plans, you should enroll in your new plan without disenrolling from your old plan. It’s best to enroll in your new plan by calling 800-MEDICARE, rather than the new plan. You will be automatically disenrolled from your previous Medicare private drug plan when your new coverage starts.

Marci’s Medicare Answers is a service of the Medicare Rights Center (www.medicarerights.org), the nation’s largest independent source of information and assistance for people with Medicare.