What you have to pay
You may be billed for the following:
Medical services and supplies that Medicare doesn’t pay for when you agree to pay out of pocket for them. The home health agency should give you a notice called the Home Health Advance Beneficiary Notice (HHABN) before giving you services and supplies that Medicare doesn’t cover. See page 11.
20% of the Medicare-approved amount for Medicare-covered medical equipment such as wheelchairs, walkers, and oxygen equipment.
Home Health Advance Beneficiary Notice
The home health agency should give you a written notice called a Home Health Advance Beneficiary Notice (HHABN) in the following situations:
The home health agency reduces or stops providing you with some home health services or supplies for business-related reasons while continuing other home health services.
The home health agency reduces or stops providing home health services or supplies because your doctor has changed your orders.
The home health agency plans to give you a home health service or supply that Medicare probably won’t pay for.
If a home health agency reduces or stops providing certain services or supplies, you may have the option to keep getting them. The HHABN will explain what service or supply is going to be reduced or stopped and give you instructions on what you can do if you want to keep getting the service or supply.
When you get an HHABN because Medicare isn’t expected to pay for a medical service or supply, the notice should describe the service and/or supply, and explain why Medicare probably won’t pay.
The HHABN gives clear directions for getting an official decision from Medicare about payment for home health services and supplies and for filing an appeal if Medicare won’t pay.
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