Does Medicare cover house calls

Does Medicare Cover House Calls? 

It’s been a long time since doctors made house calls as a standing practice. Forbes reported that house calls in the 1940s made up 40% of medical visits across the United States, an institution that began its descent in the 1960s. Projections that reverting to house calls would raise the quality of care and lower costs prompted Medicare to pilot a program called Independence at Home (IAH).

Independence at Home demonstration

In 2012, the Centers for Medicare & Medicaid Services (CMS) began to work with health care practitioners to test a theory. Would at-home primary care services be effective in improving health care for Medicare recipients subject to multiple chronic conditions? As part of the IAH pilot, or demonstration, providers are rewarded for delivering high-quality care with less expense. 

If you receive home health services from an agency in one of the following states, you may be impacted by the Medicare demonstration program. Submit a request to Medicare for a pre-claim coverage review, or ask the agency to submit the request on your behalf.

• Florida
• Illinois
• Massachusetts
• Michigan
• Texas

The premise of the program was that house calls should lessen the need for hospitalization, increase patient and provider satisfaction, and lead to favorable health outcomes overall. IAH began as a three-year demonstration and was extended twice. Some members of Congress cite positive results and have proposed legislation to make IAH permanent. In the meantime, Medicare benefits cover other ways you can receive medical services without having to leave your home.

Home health care services and qualification

Home health services are covered under Part A and/or Part B. It’s important to understand that Medicare will not pay for round-the-clock care, meal delivery or homemaker services. If you need only custodial or personal care, you would have to make your own personal payment arrangements outside of Medicare benefits.

Home health services eligible for coverage include:

• Skilled nursing care (part-time or intermittent)
• Physical therapy
• Speech-language pathology
• Occupational therapy
• Medical social services
• Home health aide (part-time or intermittent)
• Osteoporosis medication that requires an injection, applicable to women with this condition

Here is a list of the criteria that qualifies you for these services:

• Services must be medically necessary.
• A health care practitioner must see you face-to-face and then certify that the services are necessary.
• Your doctor or another qualifying medical provider has to order your care.
• Services must be rendered by a Medicare-certified home health care organization.
• You must be homebound.

For covered services, you don’t incur any cost. However, if you need durable medical equipment, you will be responsible for the Part B deductible and 20% coinsurance.

During the pandemic, covered home health services can be delivered by nurse practitioners, physician assistants (PAs) and clinical nurse specialists without a physician’s certification. 

Medicare benefit for virtual doctor visits

The benefit for virtual doctor visits, or E-visits, was introduced January 2021. E-visits offer you a channel to have a discussion with your doctor through your computer or mobile device. By registering on a patient portal, you have access to the health care providers applicable to the services you need. 

You can use E-visits for COVID-19 treatment whether you reside in your own home, an assisted living center or a nursing home.  

Resources

If you would like to learn more about the Independence at Home Act, visit iahnow.org. To check if a health care provider in your area is involved in this program, look at the map of participating practices at innovation.cms.gov/innovation-models/independence-at-home.