Home health care: Understanding types and coverage
As you age, there may be times when you need specialized care at home after a hospital stay or injury, or simply a helping hand with daily tasks.
Home health care services refer to medical services that are provided in your home by a home health agency or trained health care practitioner, as well as non-medical (non-skilled) services from an agency care provider.
Each HealthSelectSM plan covers eligible medical home health services. In addition, the HealthSelectSM Medicare Advantage Plan preferred provider organization (MA PPO) insured by UnitedHealthcare® covers some non-medical services (see below). You can find details on your plan’s website or in your plan’s Summary of Benefits and Coverage or Evidence of Coverage. You can also call the customer service number on your plan ID card to discuss your specific situation.
Medical home health care
For medical home health services to be covered, a physician must order them and a health care practitioner (such as a nurse) must provide them. Covered services could include part-time or intermittent skilled nursing and home health aide services, and physical, occupational or speech therapy.
Following are participants’ copay and coinsurance amounts for eligible home health care services from in-network providers.
- HealthSelectSM MA PPO: No copay or coinsurance
- Plans administered by Blue Cross and Blue Shield of Texas (BCBSTX):
- HealthSelect of Texas®: 20% coinsurance
- Consumer Directed HealthSelectSM: 20% coinsurance after deductible
- HealthSelectSM Secondary: No copay; 30% coinsurance for home infusion therapy
Care by out-of-network and out-of-state providers will cost more (see Comparison Charts and Premium Rates for Retirees). While some plans do not have a copay for home health visits, copays or coinsurance may apply to other services and supplies needed for the home care.
Non-medical home health care through HealthSelect MA PPO
Examples of non-medical home health care include services by a home health personal care assistant, meals after a hospital stay or rides to medical appointments. UnitedHealthcare offers several extra benefits for non-medical home health services for HealthSelect MA PPO participants. View these extra benefits and programs.
Keep in mind that even if a non-medical service does not require a physician order, you may need a referral from UnitedHealthcare before the plan will cover it. For example, meals or transportation after a hospital stay require a referral by a UnitedHealthcare Advocate and limitations may apply. Contact UnitedHealthcare at (855) 853-0453, TTY 711, 7 a.m. – 7 p.m. CT, Monday through Friday and 7 a.m.–3 p.m. on Saturday.
HealthSelect MA PPO non-medical care benefits
- Post-discharge meals (up to 28 within 30 days of an inpatient or skilled nursing facility discharge): Contact Mom’s Meals at (866) 204-6111.
- Transportation to health care appointments or the pharmacy: Up to 24 one-way trips or 12 round trips per year (up to 50 miles each way). Contact ModivCare at (833) 219-1182, TTY: (844) 488-9724, or visit the Modivcare website.
- In-home personal care: Up to eight hours per month of non-medical care, including help with meal preparation, bathing and medication reminders. (There is a two-hour minimum for shifts; unused hours do not roll over.) A separate benefit provides up to six hours of care up to 30 days after inpatient and skilled nursing facility discharges. Call (800) 337-3996 or visit the Carelinx website.