Frequently asked Care Questions

Question 1

What is the difference between home health and hospice care?

Accepted Answer

Home Health and Hospice are both provided where a patient lives, but they serve different needs. Home Health generally focuses on skilled treatment, recovery, health management, and maintaining independence after an illness, injury, surgery, hospitalization, or change in condition.

Hospice shifts the primary focus to comfort, dignity, symptom management, quality of life, and support for patients and families during a life-limiting illness. Benchmark provides both care pathways and can help families understand which may be appropriate based on the patient’s goals, condition, physician guidance, and eligibility.

‍

Home Health vs. Hospice: Understanding the Difference

Question 2

Who can make a referral to Benchmark?

Accepted Answer

A referral conversation may be started by a physician, hospital, rehabilitation facility, assisted living community, nursing facility, patient, family member, caregiver, or another healthcare provider. Formal admission requirements vary by service and payer, and Home Health generally requires physician involvement and a plan of care. Families do not need to understand every requirement before contacting Benchmark. Our team can listen to the situation, explain the next steps, and help determine what information is needed to evaluate care options.

Question 3

What happens after a referral is made?

Accepted Answer

After Benchmark receives a referral, a team member reviews the available information, contacts the patient or family, answers questions, and confirms the next steps. Depending on the service being considered, Benchmark may coordinate with the referring provider, verify coverage, gather medical documentation, and schedule an initial assessment or visit. The team evaluates the patient’s needs, eligibility, goals, home environment, and appropriate plan of care. Timing can depend on clinical needs, required documentation, payer authorization, and staff availability.

‍

What Happens After Your Doctor Refers You to Home Health?

Question 4

What areas does Benchmark serve?

Accepted Answer

After Benchmark receives a referral, a team member reviews the available information, contacts the patient or family, answers questions, and confirms the next steps. Depending on the service being considered, Benchmark may coordinate with the referring provider, verify coverage, gather medical documentation, and schedule an initial assessment or visit. The team evaluates the patient’s needs, eligibility, goals, home environment, and appropriate plan of care. Timing can depend on clinical needs, required documentation, payer authorization, and staff availability.

‍

What Happens After Your Doctor Refers You to Home Health?

Question 5

Who qualifies for Medicare-covered home health care?

Accepted Answer

Medicare may cover eligible home health and hospice services when the applicable clinical, documentation, physician, plan-of-care, and program requirements are met. The two benefits have different eligibility rules and covered services. Medicare Advantage plans and other insurance policies may also have network, authorization, or cost-sharing requirements. Because coverage depends on the patient's circumstances and plan, Benchmark can review available information and help verify benefits before care begins, but final coverage decisions are made according to the payer's requirements.

Question 6

What does homebound mean for home health eligibility?

Accepted Answer

Being homebound does not necessarily mean a person can never leave home. In general, it means leaving home requires considerable and taxing effort, assistance from another person, or supportive equipment because of illness, injury, weakness, or functional limitations. A patient may still leave home for medical treatment, religious services, or occasional brief activities and potentially remain eligible. Homebound status is determined from the patient's individual condition and documented circumstances, so Benchmark and the ordering provider must evaluate each situation rather than relying on a single example.

What Does Homebound Mean for Medicare Home Health Eligibility?

Question 7

What skilled home health services does Benchmark provide?

Accepted Answer

Benchmark Home Health provides skilled nursing, physical therapy, occupational therapy, speech therapy, home health aide support when included in an eligible plan of care, patient and caregiver education, post-hospital recovery support, and care coordination. Services are based on the patient's assessed needs and physician-directed plan of care. Home health is not the same as continuous custodial care or nonmedical companion care, and the frequency and duration of visits vary according to medical necessity, progress, coverage, and the individualized care plan.

Home Health Services

Question 8

When should a family begin asking about hospice?

Accepted Answer

A family can ask about hospice whenever a loved one has a life-limiting illness, experiences ongoing decline, has repeated hospitalizations or emergency visits, develops increasing symptoms, or when treatment is no longer meeting the person's goals. Asking for information does not require an immediate decision or commitment. Beginning the conversation earlier can give patients and families more time to understand available support, discuss goals with the physician, and receive help before a crisis occurs. Benchmark can answer questions and help determine whether a hospice evaluation may be appropriate.

When Is It Time to Ask About Hospice?

Question 9

Does choosing hospice mean giving up?

Accepted Answer

No. Choosing hospice does not mean giving up on the patient or the time that remains. Hospice changes the primary goal of care from curing the illness to improving comfort, managing symptoms, supporting dignity, and helping the patient and family make the most of each day. Patients and families continue to receive medical, emotional, spiritual, and practical support based on their needs and wishes. A hospice conversation is an opportunity to understand options and goals; it does not obligate someone to enroll.

Does Choosing Hospice Mean Giving Up?

Question 10

What services are included in hospice care?

Accepted Answer

Hospice care may include nursing visits, physician oversight, symptom and pain management, medications related to the terminal diagnosis, medical equipment and supplies, hospice aide services, social work, emotional and spiritual support, volunteer services, caregiver education, and grief or bereavement support. Services are coordinated through an individualized hospice plan of care and may change as the patient's needs change. Coverage and specific services depend on eligibility, the plan of care, payer requirements, and the patient's condition.

What Services Are Included in Hospice Care?

Question 11

Can Benchmark help me understand how my Medicare plan affects my care?

Accepted Answer

Benchmark can help you understand how your Medicare plan affects your care. Resources include Medicare, the Medicare website, and the State Health Insurance Assistance Program (SHIP).

Question 12

When is Medicare Open Enrollment?

Accepted Answer

Medicare Open Enrollment occurs each year from October 15 through December 7, with coverage changes taking effect January 1.

Question 13

Does Medicare cover home health and hospice care?

Accepted Answer

Medicare may cover eligible home health and hospice services when the applicable clinical, documentation, physician, plan-of-care, and program requirements are met. The two benefits have different eligibility rules and covered services. Medicare Advantage plans and other insurance policies may also have network, authorization, or cost-sharing requirements. Because coverage depends on the patient's circumstances and plan, Benchmark can review available information and help verify benefits before care begins, but final coverage decisions are made according to the payer's requirements.

Question 14

Can Benchmark verify insurance benefits before care begins?

Accepted Answer

Benchmark can review insurance information and help verify available benefits, network participation, authorization requirements, and potential coverage considerations before care begins. Benefit verification does not guarantee payment because final coverage depends on eligibility, medical necessity, documentation, the plan of care, payer rules, and the terms of the patient's policy. Our team will explain the information available and let the patient or family know if additional documentation or authorization is needed.

Question 15

Why is Medicare Open Enrollment important for home health plans?

Accepted Answer

Your Medicare plan affects your healthcare coverage, out-of-pocket costs, and whether your plan continues to cover services provided by Benchmark Home Health.

During Open Enrollment, we encourage you to:

Review your current Medicare benefits and costs.
Confirm your home health services will continue to be covered.
Compare available Medicare plans if your healthcare needs have changed.

Choosing the right plan can help ensure you continue receiving the care and support you need without unexpected interruptions.

Frequently asked Care Questions

GETTING STARTED

HOME HEALTH

HOSPICE CARE

MEDICARE & INSURANCE