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Marci's Medicare Answers (online only)

June 2011

By Medicare Rights Center

I need home health care. Will Medicare cover this?—Boris

Dear Boris,

Medicare will help pay for your home care if all four of the following are true:

1. You are homebound, meaning it takes a considerable and taxing effort to leave your home; and

2. You need skilled nursing care on a part-time or intermittent basis and/or you need skilled therapy services; and

3. Your doctor signs a home health certification stating that you qualify for Medicare home care because you are homebound and need intermittent skilled care. The certification must also say that a plan of care has been made for you, and that it is regularly reviewed by a doctor. Usually, the certification and plan of care are combined in one form that is signed by your doctor and submitted to Medicare.  

o Starting April 1, 2011, as part of the certification, doctors must also confirm that they (or certain other providers, such as nurse practitioners) have had a face-to-face meeting with you that was related to the main reason you need home care. This meeting must occur within 90 days of starting to receive home health care or within 30 days after you have already started receiving home health care. Your doctor must specifically state that the face-to-face meeting confirmed that you are homebound and that you qualify for intermittent skilled care.

4. You receive your care from a Medicare-certified home health agency (HHA).

—Marci

Dear Marci,

I have retiree benefits and I just became eligible for Medicare. Do I still need Medicare Part A and Part B?

—Lakshmi

Dear Lakshmi,

Usually, yes. Once you become eligible for Medicare, insurance you get from a past job (\"retiree insurance\") always pays after Medicare. Many retiree policies require you to sign up for Medicare Parts A and B. These policies may help pay for Medicare costs or for things Medicare does not cover. That means you need to enroll in Medicare Part A and Part B so that you will have full insurance coverage.

Some exceptions are:

1. If you have End-Stage Renal Disease.

2. If you have health insurance from an HMO under the Federal Employees Health Benefit Program (FEHBP), your coverage may be comprehensive enough that you will not need to sign up for Medicare Part B coverage.

Some employers sponsor Medicare private health plans (Medicare Advantage), such as Medicare HMOs and PFFS plans, for retirees who are eligible for Medicare. If you worked for one of these employers, you can get both your Medicare benefits and your retiree health benefits by signing up for a Medicare private health plan that has a contract with your former employer. Some employers require that you join a Medicare private health plan to continue getting retiree health benefits. You can always choose not to take your employer\'s coverage and sign up for Original Medicare or a Medicare private health plan that is not sponsored by your employer. However, keep in mind that you may not be able to get that retiree coverage if you want it at a later date.

Call your employee benefits office to find out how your retiree policy works with Medicare. Determine whether it pays no matter which doctors you use (or only if you use HMO doctors), and check to see whether you can get it back if you drop it or buy other insurance. —Marci

Marci’s Medicare Answers is a service of the Medicare Rights Center (www.medicarerights.org), the nation’s largest independent source of information and assistance for people with Medicare. To speak with a counselor, call (800) 333-4114. To subscribe to “Dear Marci,” the Medicare Rights Center’s free educational e-newsletter, simply e-mail dearmarci@medicarerights.org. To learn more about the services that Medicare will cover and how to change plans, log on to Medicare Interactive Counselor at the Medicare Rights Center’s website at www.medicareinteractive.org.