Your rights when your home health agency believes Medicare will reduce coverage for your care will depend on:

• Why care is being reduced; and
• Whether you have Original Medicare or a Medicare Advantage plan (Medicare private health plan)

Original Medicare

If a Medicare-certified home health agency (HHA) plans to reduce services that are in your plan of care they must give you a document called a Home Health Advance Beneficiary Notice (HHABN), a notice about your care. In this case the HHABN will explain why services will be reduced. What you should do depends on why there will be a reduction in services:

• If the services are being reduced because your doctor has agreed to a change in your plan of care you have a few options. You will either need to get your doctor to change his/her mind, get another doctor to certify you need to continue getting all the services you were getting before, or go without those services.

To find out when Medicare pays for a second opinion, click on the link in the GO TO box.

• If your care is being reduced because the HHA has decided to discontinue the care for staffing reasons, or they do not think it is safe for you to stay at home, you will need to find another HHA to get home health care, investigate other care options in your community, or go without those services.
• If your HHA decides to reduce services in the plan of care because the HHA does not think that Medicare will continue to cover these services, you will need to make a choice by checking a box on the HHABN to either
  • Turn down care—you can look for another Medicare-certified home health agency (HHA)
  • Request care but agree to pay for care yourself
  • Request care and ask the HHA to try to bill Medicare and/or other insurance (“demand bill”)

To find out how to demand bill, click on "What can I do if the home health agency agrees to give me care but says Original Medicare probably won't pay?"

Medicare private health plan

If you are in a Medicare private health plan, and your home health services are going to be reduced, you will generally have to appeal to ask your plan for a fast review or “expedited reconsideration” of this decision.

To find out how to get an “expedited reconsideration,” click on “What can I do if my Medicare private health plan refuses to let me get care I need immediately?”