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The Jeffrey P. Ossen Foundation and the Center for Medicare Advocacy have joined forces to advance access to Medicare and necessary home and community-based care. The two organizations are partnering to provide education and advocacy throughout the greater Windham area to help providers, discharge planners, and families understand and access Medicare-covered home health and community-based care.

The Center for Medicare Advocacy and Ossen Foundation plan to work closely with local health care providers, care managers, relevant community members and leaders to spread the word about Medicare coverage and the help available at the Center. The stories and challenges learned through the project will be gathered to encourage necessary systemic change to help all Medicare beneficiaries get the care they need.

The Center for Medicare Advocacy is grateful to the Ossen Foundation for supporting this important project.


Overview: Medicare Can Cover the Health Care You Need In Order To Stay In Your Home

Medicare covers certain health care provided at home when an individual is unable to leave home without help and has a doctor’s order for home care that includes skilled nursing or therapy. There is no time limit to coverage as long as the individual continues to need help leaving home and needs skilled nursing or therapy. When these standards are met, Medicare also covers care provided by home health aides.

For quite some time, the Medicare home health benefit has been misunderstood and underutilized. People are often told Medicare will not pay if a person’s condition is not “improving.” This is not true! Medicare is also available for skilled nursing and therapy intended to maintain a person’s condition, prevent deterioration, or slow decline.

What Services Are Covered Under the Medicare Home Health Benefit?

  • Skilled nursing
  • Home health aides for up to 28 hours a week combined with skilled nursing care (in some cases, up to 35 hours a week, if needed, as documented by the doctor)
  • Skilled physical therapy, occupational therapy and speech language pathology services
  • Medical social services
  • Medical supplies

Helpful Tips:

  • Family members cannot be required to help provide care in order for the patient to receive Medicare coverage.
  • Home health agencies must submit a claim to Medicare upon the request of a beneficiary. A claim decision is required in order to appeal.
  • A new rule prohibits agencies from discontinuing services without a doctor’s order.
  • The doctor is the patient’s most important ally.

Resources:


Contact us at HomeHealth@MedicareAdvocacy.org


 

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