The words you’ll hear, in plain English.

A written notice a provider gives before a service or supply that Medicare probably won’t cover, so the person can decide whether to get it and pay for it.²

A legal document that records a person’s wishes about future medical treatment.¹⁷ It can also name a health care agent to make decisions for them.¹⁶ Medicare Part B covers advance care planning as part of the yearly Wellness visit, with nothing to pay when the provider accepts assignment.¹⁷

A nurse practitioner, clinical nurse specialist or physician assistant. Like a doctor, an allowed provider can order home health and oversee the plan of care.²

Medicare’s hospice benefit runs in periods: two of 90 days, then an unlimited number of 60-day periods.⁸ A hospice doctor recertifies the terminal illness at the start of each period after the first.⁷

For hospice, the hospice doctor and the person’s regular doctor, if they have one, certify that the person is terminally ill, with a life expectancy of 6 months or less.⁷

Someone with both Medicare and Medicaid, which is Medi-Cal in California. Medicare pays first for Medicare-covered services, and Medicaid pays after Medicare and any other insurance.¹⁴

Medical equipment for use at home, such as a walker. Under Original Medicare, the person pays 20% of the Medicare-approved amount after the Part B deductible.¹

The visit with a doctor or allowed provider that home health requires. It has to happen within the 90 days before home health starts or within 30 days after,³ and it has to be about the reason for home health.²

A quick review by an independent reviewer, called a Beneficiary and Family Centered Care Quality Improvement Organization, when someone thinks Medicare-covered care is ending too soon. Ask before the services end, following the steps on the Notice of Medicare Non-Coverage.²

Help with daily living, like bathing, dressing, meals and housekeeping. Medicare doesn’t cover personal care when it’s the only care someone needs, or homemaker services that aren’t part of a home health plan.¹

Skilled nursing and therapy at home for people who are homebound and need part-time or intermittent skilled care, under a plan from a doctor or allowed provider. Under Original Medicare, covered home health services cost nothing.¹

A trained aide who helps with bathing, dressing, eating, moving and walking, under written instructions from a nurse or therapist.⁶ Medicare covers aide visits while the person is also getting skilled nursing or therapy.¹

A notice the home health agency gives before it reduces or stops some services or supplies, for example when the doctor’s orders aren’t renewed.²

Medicare’s word for when leaving home isn’t recommended because of a condition, or is hard without help, and the person normally can’t leave because it takes a lot of effort.¹ Brief trips for medical care and short, infrequent outings, like religious services, don’t change it.²

Comfort-focused care for someone whose doctors certify a life expectancy of 6 months or less, and who chooses comfort care instead of treatment to cure the illness.⁷

The signed statement that chooses Medicare’s hospice benefit instead of other Medicare-covered treatment for the terminal illness. The person can stop hospice at any time, and come back later if they’re eligible.⁷

Medicare’s word for skilled nursing needed fewer than 7 days a week, or every day for less than 8 hours a day for up to 21 days.²

The 2013 court settlement in which Medicare confirmed that coverage of skilled nursing and therapy doesn’t depend on whether the person can improve. Skilled care to keep abilities or slow a decline can be covered.¹¹

Medicare pays for four levels of hospice care: routine home care, continuous home care, inpatient respite care and general inpatient care. Inpatient respite care can’t run more than 5 days in a row.⁹

California’s Medicaid program. It covers home health that a physician prescribes under a written plan reviewed every 60 days, with prior authorization after one evaluation visit every six months.¹³

Help from a social worker with social or emotional problems that get in the way of treatment or recovery, covered when it’s part of the home health plan of care.⁶

Plans that provide Medicare Part A and Part B benefits in place of Original Medicare.² They have to follow Original Medicare’s coverage rules, but they can require an agency in their network and approval before care starts.^12,2

Reviewing a person’s complete list of medicines at every change in care, like going home from the hospital, to catch a drug left out, a therapy doubled up or a wrong dose.¹⁰

A notice given at least 2 days before all Medicare-covered home health services end. It states the end date and how to ask for a fast appeal.²

The standard set of assessment questions Medicare requires home health agencies to use at the start of care and when the assessment is updated.⁵ Patients get a privacy notice about it.¹⁸

Medicare Part A and Part B, used without a Medicare Advantage plan.² Under Original Medicare, covered home health services cost nothing.¹

Specialized medical care for people with a serious or life-threatening illness, given alongside treatment for the illness. Hospice focuses on the final months of life, and palliative care doesn’t require being at the end of life.¹⁵

The written plan a doctor or allowed provider signs for home health: the diagnoses, the services and how often they come, medicines and treatments, safety measures, goals and teaching. It’s reviewed at least every 60 days.⁴

A medical order for people with a serious illness, signed by the patient or their decision maker and by a physician, nurse practitioner or physician assistant. It doesn’t replace an advance health care directive.¹⁶

Approval a health plan requires before care starts. Medicare Advantage plans may use it only to confirm a diagnosis or other medical criteria and that the care is medically necessary.¹²

A doctor’s or allowed provider’s renewed confirmation that a person still needs and qualifies for care: at least every 60 days for home health,³ and at the start of each hospice benefit period after the first.⁷

A break for the family caregiver. In hospice, the hospice arranges inpatient respite care for up to 5 days at a time, and the person pays 5% of the Medicare-approved amount.⁷

Care that takes a nurse’s skill, such as wound care for a pressure sore or a surgical wound, teaching the patient and caregiver, IV or nutrition therapy, injections, and monitoring a serious illness or unstable health.¹

Physical therapy works on walking, strength and balance; occupational therapy on everyday tasks like bathing and dressing; speech-language pathology on speech, language and swallowing. Medicare covers all three at home for people who qualify for home health.¹