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Medicare Home Health Care Benefit May Cost You

Empty Wallet Being DisplayedCongressional panel urges a copay for Medicare home health care benefit

Just when you thought the drama surrounding changes to Medicare had died down a Medicare Payment Advisory Panel has recommended that beneficiaries pay a portion of Medicare home health care costs.

Up until now at-home recovery for Medicare beneficiaries has been a covered expense requiring a $0 copay. The Advisory panel is recommending that home health care recipients pay an unspecified copay amount somewhere in the $150 range for a series of visits. The at-home recovery benefit costs taxpayers approximately $20 billion a year and there are concerns that some people are abusing the system by creating a long term care event.

The Medicare home health care benefit is activated when a doctor signs an order to provide in-home skilled nursing visits to beneficiaries who have a verifiable medical condition and are home bound or unable to leave their home without assistance.

The panel is recommending that Medicare beneficiaries recently discharged from the hospital and low income recipients be exempt from any out-of-pocket costs. There still remains approximately 30 million people who would be required to pay a copay for Medicare home health care services.

Which Medicare plan will help with home health care costs?

This extra cost to seniors shouldn’t be a big deal right? After all their Medicare supplement or Medicare Advantage Plan should pay the extra costs. Think again.

Funding to Medicare Advantage Plans is expected to be less than in years past and any home health care benefit is uncertain. Many out-of-pocket costs required by Advantage plans are at or above the same level as original Medicare. As an example, many Medicare Advantage Plan members pay the same 20% for outpatient surgeries as those who have original Medicare.

Modernized Medicare supplement plans, also known as Medigap policies where introduced in June 2010. The re-tooling of Medicare supplement policies brought about the elimination of four standardized plans (E, H, I, and J) and added two new plans (M and N). Even the most comprehensive plan, Medicare supplement Plan F will not fill the gaps.

Currently there are no Medicare supplement policies for sale that will afford the Medicare beneficiary any coverage for Medicare covered home health care costs. Many people purchased Plan J prior to its being discontinued because it did include at-home recovery benefits.

Is a copay for Medicare home health care really the answer?

No one would argue that eliminating Medicare fraud and being fiscally responsible are not worthy goals. But the goal and the execution of the goal are not in sync.

Allowing care at home versus shuffling seniors off to short term skilled nursing facilities is surely less expensive. If a doctor can write an order for at-home recovery they are surely smart enough to game the system to get their client admitted to a skilled nursing facility. What costs more a 30 to 60 minute visit a few times per week or inpatient care around the clock?

Is this Congressional Advisory panel naive enough to believe that fraud only exists in services related to home health care or are they screaming that the sky is falling to sell their proposal. After all eliminating fraud is an easy sell. If you want to witness fraud, watch doctors give referrals like pats on the back and order unnecessary tests because they can.



How many patients who could benefit from home health care will choose to go without? Probably the same number who choose to cut their prescription drug dosage in half or go without altogether.

Trying to maintain the current health care system for seniors will require leaders who have a greater amount of vision than those on a panel approaching the problem with what amounts to scissors and duct tape. Requiring out-of-pocket costs for Medicare home health care benefits is not the answer.

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