After Connie Henderson’s husband, Eugene, was diagnosed with a rare genetic condition that causes lung problems, a doctor gave the rural Minnesota couple a bit of good news: Medicare’s home health benefit would pay for a nurse to come to their home and administer the weekly plasma infusions that Eugene would need to treat the condition.
Unfortunately, the doctor was wrong. Because Eugene was not homebound, the home health agency said, he didn’t qualify for the Medicare benefit, and the Hendersons would have to pay about $200 a week for the service. That left Connie, 66, in a bind: She could let her husband go to an infusion center at a clinic, where she feared exposure to other ill patients could damage his health, or learn to give the intravenous infusions herself. She chose the latter. At first, it was “scary,” she says. “I didn’t think we could do it.”
As the Hendersons discovered, even health providers have a hard time understanding Medicare’s home health care benefit. To qualify, you must need skilled services such as nursing, physical therapy or speech therapy. And you must be “homebound,” meaning you have difficulty leaving home without help or leaving home isn’t recommended because of your condition.
Another stumbling block: “People choose an agency that’s not Medicare-certified,” says Denise Sikora, owner of DL Health Claim Solutions, in Lady Lake, Fla. In that case, she says, “they’re not getting covered by Medicare.” Here’s where to find and compare Medicare-certified home health agencies.
Even when patients meet all the requirements, they’re often inappropriately denied benefits, says Judith Stein, executive director of the Center for Medicare Advocacy. One issue: Many Medicare beneficiaries have been told their home health coverage is ending because their condition is not improving. But “improvement is absolutely not required in order to get home care,” Stein says. Medicare will cover home health care “to maintain a person’s condition or slow their decline,” she says, “and that’s very important for people with Alzheimer’s, stroke or paralysis.”
