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Yes, the agency may decline you if it doesn’t have the ability or resources to meet your medical needs. A Medicare-certified home health agency (HHA) is not required to take you as a patient simply because your doctor has prescribed care for you and you qualify for Medicare-covered home care.
While most home health agencies will take all Medicare beneficiaries, agencies have the ability to choose the patients they accept. A home health agency may decline a patient if it doesn’t believe it can meet the individual’s health needs, as long as it does not treat that person differently from other patients. For example, if a home health agency refuses to accept you as a patient because of a medical condition you have, the organization cannot then accept other patients who have the same health condition.
If you are in a Medicare health plan, such as a Medicare Advantage plan, your plan may only pay for you to get care from home health agencies that are within the plan’s network. Check with your specific Medicare plan for more information on rules regarding providers.
A home health agency can also limit the kinds of services it provides and the types of conditions it will cover. If you need services that the home health agency does not provide, the agency can choose to reject you as a patient as long as its policies are consistent for all patients. For example, an HHA can decide it will not treat patients with dementia because it doesn’t have the resources or trained staff to do so.
In addition, an HHA can refuse to take you as a patient if it does not believe that it can ensure your safety. For example, if you need round-the-clock personal care in addition to services the home health agency provides, but you are opting to go without that care, the agency could find your situation unsafe and not accept you as a patient. Sometimes, the home health agency may decline to take you as a patient because it does not have the staff available to take on new patients.
eHealth's Medicare website is operated by eHealthInsurance Services, Inc., a licensed health insurance agency doing business as eHealth. The purpose of this site is the solicitation of insurance. Contact may be made by an insurance agent/producer or insurance company. eHealth and Medicare supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. We offer plans from a number of insurance companies.