All Medicare Advantage Plans must provide at least the same level of home health care coverage as Original Medicare, but they may impose different rules, restrictions, and costs. Depending on your plan, you may need to:

  • Get care from a home health agency (HHA) that contracts with your plan
  • Request prior authorization or a referral before receiving home health care
  • Pay a copayment for your care (Original Medicare fully covers home health)

Know that HHAs can choose who to accept as a patient or refuse to provide you with home health services if they do not believe they can ensure your safety. If no HHA in your plan’s network will take you as a patient, call your plan. Your plan must provide you with home health care if your doctor says it is medically necessary. If no in-network HHA will provide you with care, but an out-of-network HHA will, your plan must provide coverage for your out-of-network home health care. If no HHA in your area can provide you with care, speak to your doctor about other options for receiving care.

If you need information about the costs and coverage rules for home health care, or if you are experiencing problems, contact your Medicare Advantage Plan.

Return to: Medicare In-depth

This content was created and copyrighted by the Medicare Rights Center ©2020. Medicare Rights Center is a national, nonprofit consumer service organization that works to ensure access to affordable health care for older adults and people with disabilities. These materials are presented here with support from YourMedicare.com and may not be distributed, modified or edited without Medicare Rights’ consent.

YourMedicare.com takes pride in providing you as much information as possible concerning your Medicare options, but only a health insurance broker licensed to sell Medicare can help you compare your plan options from various insurance companies. When you’re ready, we recommend you discuss your needs with a YourMedicare.com Licensed Sales Agent.