Home Health Copay
Dear Editor: Dr. Bruhl presented an update on SEARHC Home Health at the Sitka Assembly meeting Tuesday evening. I attended. During his presentation, Dr. Bruhl attempted to persuade the Assembly that SEARHC is providing the same Home Health services that it did before the closure of its Medicare-Certified Home Health agency.
I doubt that Dr. Bruhl is trying to deliberately mislead the community but, quality of care aside, his presentation failed to mention the significant increase in out-of-pocket expenses under what SEARHC now calls its “SEARHC Outpatient Home-Based Services Program.”
The bottom line: Medicare recipients who received free Home Health prior to the closure of the SEARHC Home Health office will now pay a 20% copayment for each home visit. This is not trivial. Medically fragile home-bound patients frequently need regular care from nurses, physical-, occupational-, and/or speech therapists. SEARHC charges $66 for a basic nurse visit, but if the nurse provides any service such as catheter placement or changing, wound care and dressing change, or injectable drug administration – which are routinely required by medically fragile home-bound patients – charges “range between $100 and $500.” Rehab services such as physical and occupational therapy are billed based on time and “range from $100 to $125 per 15-minute increment” (SEARHC Home-Based Services Financial Resource). Thus, a patient who receives weekly home-based services from multiple providers is looking at hundreds or even thousands of dollars a month in copayments.
Furthermore, SEARHC’s “sliding fee discount” is unimpressive. A patient with a monthly two-person household income of $2,053 (annual income of $24,636) pays a $25 copayment per visit, and that amount increases rapidly with increased income. At the top of the sliding-fee scale, a two-person household with a monthly income of $3,594 (annual income of $43,128) pays a $100 copayment for home-based visits. Again, a typical medically fragile home-bound patient and their family is looking at hundreds or thousands of dollars a month in copayments under SEARHC’s sliding fee discount.
For those interested in a more detailed explanation of this change in billing and reimbursement under SEARHC’s new “home-based services”: Medicare, which provides health insurance for people who are 65 and older, is a federal entitlement program. Entitlement programs are rights granted to citizens by federal law. Americans must participate in the Medicare program through payroll taxes defined by federal law. The average-wage American worker pays $61,000 in lifetime contributions into Medicare.
Among other benefits, Medicare provides Home Health free of charge through Medicare Part A, the hospitalization insurance portion of Medicare. This is because home health is so effective for preventing emergency room visits and hospitalizations that it saves Medicare money in the long run.
However, “Medicare’s home health benefit only pays for services you get from the (Medicare certified) home health agency” (https://www.medicare.gov/publications/10969-medicare-and-home-health-care.pdf, p. 7). And because they no longer operate through a Medicare-Certified Home Health agency but are delivered through SEARHC’s outpatient clinics, SEARHC home-based services are not covered by Medicare Part A. Instead, they are covered at 80% by Medicare Part B, the medical insurance portion, leaving patients with a 20% copayment.
Adding insult to injury, because Medicare recipients have paid federal Medicare taxes on their wages – an average of $61,000 per earner – Medicare recipients receiving SEARHC home-based services are essentially paying twice – once through Medicare contributions from lifetime wages, and again in the form of a 20% copayment for services that should be provided free of charge as part of their Medicare entitlement.
SEARHC is depending on our ignorance to gloss over this significant change in its home health program. I only know better because my husband, Tony Guevin, was a beneficiary of home health for two years before his death in 2019. Because it was provided through Sitka’s then-Medicare-Certified Home Health, we did not receive a single bill for home health services during those two priceless years.
But please don’t believe me. Check with Medicare (Medicare.gov or 1-800-633-4227). Or call and ask SEARHC.
Cindy Litman, Sitka
