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Seniors Often Must Fight for Medicare Home Health
Benefits
By: ElderLawAnswers.com
 Aug.
4, 2005 - 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. 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 – meaning that
leaving it 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.
-
You must receive the services from a certified home
health agency.
Requiring an element of skilled care also will
entitle you to Medicare coverage of social services, home health aide
services, and the necessary medical supplies and equipment. You won't
have to pay anything for the home health benefits, but you will have to
pay 20 percent of the supplies and equipment.
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 have to appeal,
the good news is that most people win their cases. In fact, 81 percent
are successful on appeal to an administrative law judge.
If you can you should continue to pay privately for
the care during the 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, then have the physician send a letter
detailing the level of care you need.
-
Consult with a Medicare assistance agency or your
attorney to determine the likelihood of a successful appeal.
If you decide to appeal, do so immediately and make
sure you make arrangements to pay privately pending the result of the
appeal.
For more about your rights under Medicare, by
ElderLawAnswers.com -
click here.
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