There are important differences in coverage between home health care and nursing home care. The most crucial difference is that home health care can be covered by Medicare, whereas long-term care services in nursing homes are not. For a long-term nursing home, care is typically defined as non-medical custodial, which is not covered by Medicare. Original Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance) cover eligible home health services like these: Part-time or “intermittent” skilled nursing care Physical therapy Occupational therapy Speech-language pathology services Medical social services Part-time or intermittent home health aide services (personal hands-on care) Injectable osteoporosis drugs for women Usually, a home health care agency coordinates the services your doctor orders for you. Original 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. The exact benefits and copays, coinsurance, and deductibles you are responsible for vary depending on whether you are enrolled in Original Medicare, Medicare Advantage, or a Medicare Supplement.

Kevin Leinum Medicare Agent – your local Medicare Expert

HMO stands for Health Maintenance Organization and is a type of plan that requires you to see doctors in its network. If you see a doctor outside the network, you will be responsible for all of the costs. The only exception to this is medically necessary emergency or urgent care services. There is also a variation of HMO plans called HMO-POS, which stands for Health Maintenance Organization-Point of Service. These types of plans are similar to HMOs in that you are required to receive most services within the network. However, they have a bit more flexibility and allow you to go out of network for certain services or up to a certain dollar amount. Each plan works differently, so you will need to check to see what is covered out of network for your plan. PPO stands for Preferred Provider Organization and has the most flexibility in allowing you to see doctors out of network. PPO plans have two tiers, an in-network and out-of-network tier. If you see a doctor in-network, you will typically pay less out-of-pocket for those services. If you see a doctor out-of-network, you will typically have higher out-of-pocket costs, but the services are still covered. Call Kevin Leinum Medicare Agent – your local Medicare Expert about what Medicare covers or how enrolling in a Medicare Advantage or Medicare Supplement plan can improve your coverage and reduce your out-of-pocket costs.

First off, let’s define what Medicare assignment is and the impact it can have on your out-of-pocket costs. One of the most significant potential gaps in Original Medicare is healthcare providers’ ability to bill you for something called excess charges if they don’t accept Medicare Assignment. They may still accept you as a Medicare patient, but they are allowed to bill you for excess charges by not accepting Medicare Assignment. Medicare “Excess Charges” are related to Medicare Part B services. If you are on Medicare and go to a doctor who does not accept Medicare assignment (accept full payment by Medicare), they are allowed to bill you up to 15% above and beyond what Medicare approves for a specific procedure/doctor office visit.

So how do you know if your doctor accepts Medicare assignment? It is simple, ask them or their office staff.

Call Kevin Leinum Medicare Agent – your local Medicare Expert about what Medicare covers or how enrolling in a Medicare Advantage or Medicare Supplement plan can improve your coverage and reduce your out-of-pocket costs.