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CENTERS FOR MEDICARE & MEDICAID SERVICES
Medicare andHome Health Care
This is the official government bookletabout Medicare home health care benefitsfor people in the Original Medicare Plan.This booklet has important informationabout the following:
Who is eligibleWhat services are coveredHow to find and compare home health agenciesYour Medicare rightsWhere to get more information
 
Many health care treatments that used to be done only in ahospital can now be done in your home. Health care given inthe home is usually less expensive, more convenient, and justas effective as care you get in a hospital or skilled nursingfacility. If you are eligible, Medicare pays for you to get certainhealth care services in your home. This is known as theMedicare home health benefit.This book explains the Medicare home health benefitincluding the following:The conditions you must meet to be eligible What home health services are covered by theOriginalMedicare PlanInformation on comparing and choosing home healthagencies Where to go for more information, including extra helppaying your Medicare costs if you have limited income andresources•••If you get your Medicare benefits through aMedicare HealthPlan, other than the Original Medicare Plan, check your plan’smembership materials and call the plan for details about how the plan provides your Medicare-covered home health benefits.The information, telephone numbers, and web addresses inthis booklet were correct at the time of printing. Changes may occur after printing. To get the most up-to-date informationand Medicare telephone numbers, visitwww.medicare.gov onthe web. Or, call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.“Medicare and Home Health Care” isn’t a legal document.Official Medicare Program legal guidance is contained in therelevant statutes, regulations, and rulings.
 
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2Section 1:Medicare Coverage of Home Health Care . . . .3–10
 Who is eligible to get Medicare-covered home health care? . . . .3–4How the Original Medicare Plan pays for home health care . . . . .5 What the Original Medicare Plan covers . . . . . . . . . . . . . . . . .6–7 What isn’t covered by the Original Medicare Plan . . . . . . . . . . . .7 What you have to pay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7Home Health Advance Beneficiary Notice (HHABN) . . . . . . . . .8 Your right to a fast appeal when covered home healthservices are ending . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9General Medicare appeal rights . . . . . . . . . . . . . . . . . . . . . . . . . .10
Section 2:Choosing a Home Health Agency . . . . . . . . . .11–14
Finding a Medicare-certified home health agency . . . . . . . . . . . .11Comparing home health agencies. . . . . . . . . . . . . . . . . . . . . . . . .11Comparing quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11Home Health Agency Checklist . . . . . . . . . . . . . . . . . . . . . . . . .12Special rules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13Find out more about home health agencies . . . . . . . . . . . . . . . .13
Section 3:Getting Home Health Care . . . . . . . . . . . . . . .15–17
Getting started . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15 Your plan of care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15 Your rights as a person with Medicare . . . . . . . . . . . . . . . . . . . .16Home Health Care Checklist . . . . . . . . . . . . . . . . . . . . . . . . . . .17
Section 4:Medicare Prescription Drug Coverage(Medicare Part D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19
Medicare offers prescription drug coverage . . . . . . . . . . . . . . . . .19Find out more about Medicare prescription drug coverage . . . . .19
Section 5:Getting the Help You Need . . . . . . . . . . . . . . .21–27
Help for people with limited income and resources . . . . . . .21–23Help with questions about home health coverage . . . . . . . . . . . .24 Where to file a complaint about the quality of your homehealth care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24How to report fraud . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25 Words to know . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26–27
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29
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