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We get a lot of questions about what and when is home care covered?

Home care is covered by Medicare when a doctor orders a plan of care for necessary services for someone who is homebound because of chronic illness or injury. Someone is considered ‘homebound’ when he or she has trouble leaving home without the help of either a person or medical equipment because of illness or injury.

A patient whose doctor recommends not leaving home because of a medical condition is also considered homebound.

Home care is generally covered under Medicare Part B. But it can be covered through Part A in some cases after you have been in a hospital as an inpatient for at least three days, or a Medicare-covered skilled nursing facility. In that case, Medicare Part A can cover your first 100 days of home care. Part B covers any days beyond 100. But either way, you don’t have any cost-sharing for covered benefits.

The home health agency sends the bills to Medicare, and the agency must tell you if Medicare won’t cover any items or services its workers provide and the related costs you will incur.

People can qualify for additional options with Home & Community-Based Services (HCBS) Waivers Medicaid or ABD Medicaid. States can offer a variety of unlimited services under an HCBS Waiver program. Programs can provide a combination of standard medical services and non-medical services. Standard services include but are not limited to: case management (i.e. supports and service coordination), homemaker, home health aide, personal care, adult day health services, habilitation (both day and residential), and respite care. States can also propose “other” types of services that may assist in diverting and/or transitioning individuals from institutional settings into their homes and community.

You can apply for these services using the Department of Human Services website for your state, click the button below to visit the PA Independent Enrollment Broker (PA IEB) page.

Learn more: https://paieb.com/en

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Fact finding prior to a Medicare appointment can save you a lot of time. No one likes sitting down for an appointment only to find out the client isn’t even enrolled into Original Medicare Part A or B yet. Or, you are puzzled by the enrollment period you are going to use to get them on a policy as soon as possible, especially when they continue to work past age 65.

There can be times that the hardest part of being a Medicare sales agent is piecing together the situation at hand to see if you have opportunity for a potential new client. Either they give you mixed signals, or not enough information to help carve a clear path to the end goal. I found an amazing step-by-step question guide that CMS created to help walk you and your client through each “if that, then this” situation. It takes the guess work or self-doubt out of the equation.

Learn more

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Health Savings Accounts help pay for deductibles, coinsurance, copayments, and other medical expenses. Once the money goes into the Health Savings Account account, you can withdraw it for any medical expense, tax-free. Additionally, you can earn interest, your balance carries over each year, and this can become an investment for a retirement fund.

The rule reads that you should stop contributing to your Health Savings Account (HSA) six months before you're enrolled into Medicare. This is because if you continue to contribute and your Medicare coverage becomes retroactive, you may have to pay tax on those contributions. You cannot be enrolled in Medicare Part A or B, so you have to disenroll or reject both if you wish to continue to contribute to your HSA.

More key facts:

It's simplest to lay out the facts followed by an example to best help taxpayers and their advisers apply the nuances to specific situations:

• HSA contributions (including employer-provided ones) are disallowed when other coverage is in place, including Medicare Part A. Workers can still enroll in HSA-eligible plans and use funds already in HSAs for eligible expenses; they just can't contribute further once they are enrolled in Medicare.
• Workers may opt to participate in an HSA-eligible plan after enrolling in Medicare, typically because it's the only plan available to them at their workplace or because the lower premiums justify the choice, but they cannot contribute additional funds to their HSA nor can they accept contributions from their employer without penalty.
• There is a six-month lookback period (but not before the month of reaching age 65) when enrolling in Medicare after age 65, so a best practice is for workers to stop contributing to their HSA six months before the month they apply for Medicare to avoid penalties. Note that the month of application is what is used to calculate the six-month lookback, not the month the applicant wishes to begin benefits. See the examples below for more on this.
• Funds already in the HSA can still be used for qualified medical expenses upon enrollment in Medicare, including to reimburse taxpayers for Medicare premiums (but not premiums for Medicare supplemental insurance, aka "Medigap") as well as to pay for long-term-care costs and insurance premiums up to certain limits.
• If a worker is already collecting Social Security upon turning age 65, he or she will be automatically enrolled in Medicare and henceforth no longer be able to contribute to his or her HSA. The only way to opt out of this would be to rescind the Social Security election (within 12 months) and pay back all benefits received to date.
• A worker enrolling in Social Security upon reaching full retirement age will automatically be enrolled in Medicare Part A and consequently cannot make HSA contributions.

Learn more: https://www.medicareinteractive.org/get-answers/coordinating-medicare-with-other-types-of-insurance/job-based-insurance-and-medicare/health-savings-accounts-hsas-and-medicare