Your costs in Original Medicare
- $0 for home health care services.
- 20% of the Medicare-approved amount for Durable medical equipment (DME) [Glossary] .
Before you start getting your home health care, the home health agency should tell you how much Medicare will pay. The agency should also tell you if any items or services they give you aren’t covered by Medicare, and how much you’ll have to pay for them. This should be explained by both talking with you and in writing. The home health agency should give you a notice called the Advance Beneficiary Notice” (ABN) before giving you services and supplies that Medicare doesn’t cover.
If you get services from a home health agency in Florida, Illinois, Massachusetts, Michigan, or Texas, you may be affected by a Medicare demonstration program. Under this demonstration, your home health agency, or you, may submit a request for pre-claim review of coverage for home health services to Medicare. This helps you and the home health agency know earlier in the process if Medicare is likely to cover the services. Medicare will review the information and cover the services if the services are medically necessary and meet Medicare requirements.
Your Medicare home health services benefits aren’t changing and your access to home health services shouldn’t be delayed by the pre-claim review process. For more information, call us at 1-800-MEDICARE.
Things to know
During the COVID-19 pandemic, nurse practitioners, clinical nurse specialists, and physician assistants can now provide home health services, without the certification of a physician.