Medicare Advantage plans must follow Original Medicare’s rules for providing you care, but they can impose different costs and restrictions. You may need to choose a home health agency (HHA) that contracts with your Medicare Advantage plan (private health plan) to get care. You may also have to get your plan's prior approval or a referral before receiving home health care. Although Original Medicare does not charge a copayment, some Medicare Advantage plans do.
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 network HHA will take you, but a non-network one will, your plan must pay for your care that you receive from the non-network HHA. If you cannot find an HHA in your area that is able to take you as a patient, talk with your doctor and your plan about other options that are available to you.
Call your State Health Insurance Assistance Program (SHIP) for more assistance. You can call 800-Medicare to find the number of your local SHIP.
To visit your State Health Insurance Assistance Program Directory (SHIP Directory), click on the link in the LINKS box.
To find out how to appeal if your private health plan denies you care, click on the link in the GO TO box.