I feel I may need home health care. What requirements do I have to meet for coverage?

To receive coverage for home health care, you must meet the following requirements:

• Must be confined to the home
• Services are provided under a plan of care established by a physician
• Need skilled nursing care on an intermittent basis
• Need physical therapy, speech language pathology or occupational therapy
• Durable medical equipment and supplies. This includes items such as wheelchairs, hospital beds, oxygen and walkers

I am receiving home health care. What expenses will Medicare cover?

Medicare will cover the following home health care items:

• Part-time skilled nursing care
• Physical therapy
• Speech/language therapy
• Home health aide services
• Durable medical equipment and supplies. This includes items such as wheelchairs, hospital beds, oxygen and walkers

What do I pay for while receiving home health care?

You pay nothing for home health care services. You will have to pay 20 percent of the approved amount for durable medical equipment and supplies.

My doctor told me that Medicare will only cover home health care if I need skilled services. What does this include?

Your doctor is right. Medicare will only pay for home health care if you need skilled nursing and/or therapy services. A skilled service must be administered or supervised by a nurse or therapist. Services include, but are not limited to, administration of medications, tube feedings, catheter changes, wound care, therapeutic exercises, gait training, and maintenance therapy.

If you need skilled care, Medicare may also pay for a limited amount of personal care given by home health aides, like bathing, using the toilet, or help in getting dressed. Talk to your doctor about your home health care needs.

My mother has a chronic illness and is eligible for the Medicare home health benefit. Will it pay for her round-the-clock care?

No, Medicare will not cover 24-hour-a-day care at home. It also will not pay for homemaker services like shopping, cleaning and laundry, or meals delivered to her home. Medicare will pay for some personal care from home health aides, like bathing, using the toilet or help in getting dressed if she has a skilled need. But the number of hours a week Medicare will pay for is limited. Your mother can supplement home health aide services she receives through Medicare with services she pays for herself. If she qualifies for Medicaid, it will sometimes cover the cost of additional home care services.

Can I use the Medicare home health benefit even without an acute illness or a prior hospitalization?

Yes. As long as you have a need for skilled care and you are homebound, you can qualify for the home health benefit. For example, if you are recovering from hip replacement surgery, cannot leave your home yet and need physical therapy to help you learn to walk again, you qualify for the home health benefit.

You do not qualify for the home health benefit if you only need custodial care. For example, if you have Alzheimer's disease and need home health aide services to bathe and eat, but do not need skilled nursing or therapy, you will not qualify for the home health benefit.

My home health agency is stopping its services in the middle of my plan of care. What can I do?

Contact your doctor immediately and find out if she approved the termination of care. If your doctor did approve it, but you believe you need more care, you should talk to her and get a new plan of care.

If your doctor disagrees with the Medicare-certified home health agency (HHA), then the HHA must provide you with a written notice called an Advance Beneficiary Notice (ABN) that tells you that your services are terminating and explains your rights under Medicare to "demand bill." That is, you request that the agency bill Medicare, which decides if you are still eligible for home health care coverage. When you demand bill, the HHA must continue to provide services according to the plan of care. You also agree to pay privately for home health care you receive if Medicare determines you are no longer eligible.

If Medicare decides that you still qualify for home health care coverage, you are not liable for payment and the HHA must continue with the plan of care. If Medicare denies the claim, you have the right to appeal. If you do not win the appeal, you are liable for the cost of the care.