Special Needs Plans
What is a Special Needs Plan? A coordinated care plan (CCP) for Medicare Advantage (MA) known as a special needs plan (SNP) is created expressly
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Home health services coverage
Home health services: Medicare insurance Part A (Hospital Insurance) and/or Medicare insurance Part B (Medical Insurance)
cover eligible home health services like these:
- Physical therapy
- Occupational therapy
- Speech-language pathology services
- Medical social services
- Part-time or intermittent home health aide services (personal hands-on care)
- Injectible osteoporosis drugs for women
Usually, a home health care agency coordinates the services your doctor orders for you.
Medicare doesn’t pay for:
- 24-hour-a-day care at home
- Meals delivered to your home
- Homemaker services (like shopping, cleaning, and laundry), when this is the only care you need
- Custodial or personal care (like bathing, dressing, or using the bathroom), when this is the only care you need
Who's eligible?
All people with insurance Part A and/or insurance Part B who meet all of these conditions are covered:
- You must be under the care of a doctor, and you must be getting insurance services under a plan of care created and reviewed regularly by a doctor.
- You must need, and a doctor must certify that you need, one or more of these:
- Intermittent skilled nursing care (other than drawing blood)
- Physical therapy, speech-language pathology, or continued occupational therapy services. These services are covered only when the services are a specific, safe, and effective treatment for your condition. The amount, frequency, and time period of the services need to be reasonable, and they need to be complex, or only qualified therapists can do them safely and effectively. To be eligible, either: 1) your condition must be expected to improve in a reasonable and generally predictable period of time, or 2) you need a skilled therapist to safely and effectively make a maintenance program for your condition, or 3) you need a skilled therapist to safely and effectively do maintenance therapy for your condition. The home health agency caring for you is approved by Medicare (Medicare-certified).
- You must be homebound, and a doctor must certify that you’re
.
You’re not eligible for the home health insurance benefit if you need more than
. You may leave home for medical treatment or short, infrequent absences for non-medical reasons, like attending religious services. You can still get home health care if you attend adult daycare.
| Note |
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Home health insurance services may also include medical supplies for use at home, durable medical equipment, or injectable osteoporosis drugs. |
Your costs in Original Medicare
- $0 for home health insurance care services.
- 20% of the
for
.
Before you start getting your home health insurance care, the home health agency should tell you how much Medicare will pay. The agency should also tell you if any items or services they give you aren’t covered by Medicare, and how much you’ll have to pay for them. This should be explained by both talking with you and in writing. The home health agency should give you the Advance Beneficiary Notice” (ABN) notice before giving you services and supplies that Medicare insurance doesn’t cover.
| Note |
|---|
If you get services from a home health agency in Florida, Illinois, Massachusetts, Michigan, or Texas, you may be affected by a Medicare demonstration program. Under this demonstration, your home health agency, or you, may submit a request for pre-claim review of coverage for home health services to Medicare. This helps you and the home health agency know if Medicare is likely to cover the services earlier in the process. Medicare will review the information and cover the services if the services are medically necessary and meet Medicare requirements. Your Medicare home health services benefits aren’t changing and your access to home health insurance services shouldn’t be delayed by the pre-claim review process. For more information, call us at 1-800-MEDICARE. |
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