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Questions

Common questions about home health care and Medicare. If yours isn't here, call and ask.

Call (818) 717-7181
Does Medicare pay for home health care?
For patients who qualify, yes. Medicare Part A and Part B cover home health care. With Original Medicare, covered home health services cost the patient nothing. Medicare Advantage plans set their own costs and work with their own lists of agencies. Medical equipment such as a walker or hospital bed is billed separately: Medicare usually pays 80% of the approved amount, after the yearly Part B deductible. We check the patient's coverage before care starts, so you'll know where things stand.
Who qualifies for Medicare home health care?
The patient has to be under the care of a doctor or another approved provider, such as a nurse practitioner, who sets up the plan of care and reviews it regularly. That provider has to certify that the patient is homebound and needs part-time skilled nursing, physical therapy, or speech therapy. They also have to see the patient about the condition that needs home care, in the 90 days before care starts or the 30 days after. Medicare calls this the face-to-face visit. Sometimes that can be a video visit. A hospital stay first isn't required, and the care has to come from a Medicare-certified agency like ours. If you're unsure whether your parent qualifies, call us and we'll go through it with you.
What does homebound mean?
Medicare considers someone homebound when two things are true. First, they need help to leave home, such as a walker, a wheelchair, or another person, or their doctor has said going out isn't safe for them. Second, they usually can't leave home, because going out takes a lot of effort. Homebound patients can still leave for medical appointments, religious services, adult day care, and short, occasional outings like a trip to the barber.
Do we need a doctor's order?
Yes. Home health care has to be ordered by the patient's doctor or another approved provider, such as a nurse practitioner or physician assistant. In the hospital, the discharge planner can usually arrange it, and you can ask for us by name. If the patient is already home, call us and we can contact the doctor's office for you.
Is this the same as a caregiver who stays all day?
No. Home health care is part-time. Nurses, therapists, and aides come for scheduled visits and then leave, and Medicare doesn't cover round-the-clock care at home. If the patient needs someone with them most of the day, we can talk through what Medicare covers and what it doesn't.
What should I have ready when I call?
The patient's name, date of birth, and address, their Medicare or insurance card, and the name and phone number of their doctor. Discharge papers and a medication list help too, if you have them. Don't worry if you're missing something; we can start the paperwork without it.
Which areas do you serve?
We care for patients at home in Los Angeles (including the Antelope Valley), Ventura, Orange, San Bernardino, Riverside, Kern, and San Diego counties. Our office is in Porter Ranch. If you're not sure whether we reach your parent's address, call (818) 717-7181 and ask.
How soon can care start?
It depends on when we receive the doctor's order and confirm the patient's coverage. Call us and we'll give you a realistic start date for your situation.
Do you take insurance other than Medicare?
Yes. We accept Medi-Cal. We also work with these health plans and care networks: Blue Zones Health, VA Community Care Network, TriWest Healthcare Alliance, TRICARE, Blue Shield of California, Blue Shield of California Promise Health Plan, Optum, UnitedHealthcare, CalOptima Health, Prime Healthcare, and Molina Healthcare. Acceptance depends on the patient's specific plan, authorization requirements, location, and service availability. If the patient's plan isn't on that list, call us at (818) 717-7181 with their insurance information and we'll check before care starts.
Can a hospital or doctor's office refer a patient?
Yes. Discharge planners, case managers, and physicians' offices can call (818) 717-7181 or fax referrals to (818) 717-7191. Our referral page lists what to include.
What happens when home health care ends?
Home health care ends when the goals in the plan of care are met, or when the patient no longer qualifies. With Medicare, you get a written notice at least two days before covered care ends, and you can ask for a fast appeal if you think it's too soon. If the patient's health changes later, the doctor can order home health care again.

Resources

Official pages on Medicare, Medi-Cal, and other coverage. They open in a new tab.