All Medicare Advantage Plans must provide at least the same level of home health care coverage as Original Medicare, but they may impose different rules, restrictions, and costs. Depending on your plan, you may need to:
- Get care from a home health agency (HHA) that contracts with your plan
- Request prior authorization or a referral before receiving home health care
- Pay a copayment for your care (Original Medicare fully covers home health)
Know that HHAs 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. If no HHA in your plan’s network will take you as a patient, call your plan. Your plan must provide you with home health care if your doctor says it is medically necessary. If no in-network HHA will provide you with care, but an out-of-network HHA will, your plan must provide coverage for your out-of-network home health care. If no HHA 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.