If you are about to lose your home health services because Medicare will no longer pay for them, you can appeal the decision. Many recipients are unaware that they can appeal a Medicare termination of services, but they can. In addition, the chances for a favorable outcome are good because most Medicare recipients win their cases. You will, however, have to pay for your care in order to have an appealable issue. This is because the issue is the termination of service, but the denial of Medicare coverage for the service.

If your benefits are reduced or terminated, you should do the following:

  • Ask your home health agency for a detailed, written explanation and reason for the termination of services.
  • Ask your physician to call the agency to request that them to not cut back or terminate the services and to provide documentation certifying the level of needed care. This is crucial whether or not you ultimately receive the benefits you deserve.
  • Consult an elder law attorney or your state’s Medicare assistance agency to determine your chances of winning your appeal.
  • If you decide to appeal, do it immediately. Arrange with your home health agency to pay for the services pending the outcome of the appeal.

Medicare used to stop paying for home care services whenever a recipient’s condition failed to improve, which was illegal. As a result of a settlement of a lawsuit filed in 2011, Medicare no longer engages in this practice. Therefore, beneficiaries requiring skilled care to maintain their current state of health or prevent further deterioration should continue to receive coverage.