Home Health & Hospice

Insider's Scoop: Medicare Advantage Plans

Homecare Insider, August 15, 2016

Editor’s note: The following is an excerpt from The How-to Guide to Home Health Billing, Second Edition.

Medicare also contracts with a private company to offer patients their Part A and Part B benefits. Medicare Advantage Plans include HMOs, PPOs, private fee-for-service plans, special needs plans, and Medicare medical savings account plans. Services are paid for by the private company and not under Original Medicare.

Medicare Part A
Medicare Part A helps cover hospital inpatient care, skilled nursing facilities, hospice care, and home health care. Beneficiaries must meet certain required conditions to qualify for these benefits. Individuals and their spouse, who paid the Medicare tax while working, do not pay a monthly premium for the Medicare Part A benefit. Most people meet the requirement for a premium-free Part A; however, if they don’t meet the requirements for a premium-free Part A, it is available for those for a monthly fee.

Medicare Part A covers eligible home health services such as intermittent skilled nursing care, physical therapy, speech-language pathology services, continued occupational services, social services, home health aide services, and medical supplies used in the home.

Medicare doesn’t pay for:

  • 24-hour-a-day care at home
  • Meals delivered to your home
  • Homemaker services
  • Personal care

Medicare Part B
Most people pay a monthly premium for Medicare Part B. Medicare Part B helps cover doctors’ services outpatient care, outpatient therapy services, and limited home health care. Medicare Part B helps pay for these covered services and supplies when deemed to be medically necessary.