Medicare Advantage Plans and Home Health Care

Medicare Advantage Plans can be confusing. Often we receive calls from clients seeking in-home care believing their Medicare Advantage plan will cover the cost of our services.

All Medicare Advantage Plans must provide at least the same level of home health care coverage as Original Medicare. However, they may impose different costs, rules, and limitations. Depending on your plan, you may need to

-Request prior authorization or a referral before receiving home health care.

-Pay a copayment for your care.

-Get care from a home health agency (HHA) that contracts with your plan.

Unfortunately, Abby Services In-Home Caregivers does not have any established Medicare contracts at this time. However, that does not mean we can’t or won’t help you.

Please contact us to discuss options. We may be able to establish a contract or get approved by your provider.

Please be aware however that home health agencies can choose who to accept as a patient or refuse to provide you with home health services if they do not believe they can ensure your safety. Often the best source of information is your Medicare Advantage Plans call center. They can tell you who they work with in your area.

If there is not a Home Health Agency or available caregiver in your plan’s network Abby Services can possibly take you as a patient. First, you should call your plan to determine what details are necessary to consider. Your Medicare Advantage Plans insurance provider will not speak directly with Abby Services because of privacy concerns. Your plan must provide you with home health care if your doctor says it is medically necessary.

If no in-network Home Care Provider will offer you caregivers, but an out-of-network service will, your plan must provide coverage for your out-of-network home health care.

If no service including Abby Services in your area can provide you with care, speak to your doctor about other options for receiving care.

If you need information about the costs and coverage rules for home health care, or if you are experiencing problems, contact your Medicare Advantage Plan. Another excellent resource is SHINE, which we covered in a blog post some time ago. SHINE (Serving Health Insurance Needs of Elders) is a free program offered by the Florida Department of Elder Affairs and your local Area Agency on Aging.

SHINE has Specially trained volunteers who can assist you with your Medicare, Medicaid, and health insurance questions by providing one-on-one counseling and information. SHINE services are free, unbiased, and confidential.

The abundance of information can be confusing but we are here to help. Call today to speak with one of our Senior Care professionals! 239-590-0861