What Is Medicare Home Health Care?

Medicare may cover medical care you receive in your home if you meet certain rules. This care is meant to help you recover from illness or injury and stay safely at home.

Coverage is available through Original Medicare (Part A and/or Part B).

Who Can Get Medicare Home Health Care?

You may qualify if ALL of the following apply:

1. 1. You have Medicare Part A or Part B (or both)
   2. Your doctor orders home health care
   3. You need skilled care (nursing or therapy)
   4. Care is part-time or intermittent
   5. You are considered homebound
   6. Care is provided by a Medicare-certified home health agency

Homebound means leaving home is difficult and requires effort or help. You can still leave home occasionally for:

• Medical appointments
• Religious services
• Short family or personal events

What Services Does Medicare Cover?

If medically necessary, Medicare may cover:

• Skilled nursing care
• Physical therapy
• Occupational therapy
• Speech therapy (speech language pathology)
• Home health aide services
  (only if you’re also receiving skilled care)
• Medical social services (if ordered)
• Medical supplies (such as wound care supplies)

Wheelchairs, walkers, and other medical equipment are covered separately.

What Is NOT Covered?

Medicare does not cover:

• 24-hour or live-in care
• Meals delivered to your home
• Housekeeping or shopping only
• Personal care alone (bathing or dressing) without skilled care

What Will I Pay?

Most people pay $0 for covered home health services. You may pay some costs for medical equipment or non-covered items. Medicare pays the home health agency directly

How Does Care Work?

1. 1. Your doctor creates a plan of care
   2. Care is provided in 30-day periods
   3. Services must be reviewed and approved regularly
   4. Care continues only if it remains medically necessary

Choosing a Home Health Agency

You may choose any Medicare-certified agency in your area if you have Original Medicare. Agencies must meet federal quality standards. Medicare Advantage plans may limit which agencies you can use.

Know Your Rights

You have the right to:

• Be informed about your care and costs
• Help make decisions about your care
• Receive respectful and private treatment
• File complaints or appeals

Call our Appointment Hotline at (408) 350-3288, or visit our Appointments page to view available in-person counseling sites throughout Santa Clara County.

This project was supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $432,451.00 with 100 percent funding by ACL/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by ACL/HHS, or the U.S. Government. Support provided by the California Department of Aging.

CA Health Insurance Counseling & Advocacy Program (HICAP) 1.800.434.0222

Sourcewise 3100 De La Cruz Blvd, Suite 310, Santa Clara, CA 95054

When major sporting events, such as the Super Bowl, take place in Santa Clara County, they may bring increased traffic, travel, and large crowds. These changes can affect daily routines, transportation, and access to services.

Sourcewise supports older adults, caregivers, and community members by sharing information and resources to help people stay informed, prepared, and connected.

If you are currently enrolled in a Medicare Advantage (Part C) plan, there is a special window each year that gives you a chance to make changes if your plan is not meeting your needs. This period is called the Medicare Advantage Open Enrollment Period (MAOEP).

• When is MAOEP?
  • MAOEP runs January 1 through March 31 each year.
• Who Can Use MAOEP?
  • You can use MAOEP only if you are already enrolled in a Medicare Advantage plan.

What Changes Can You Make?

During MAOEP, you may:

• Switch from one Medicare Advantage plan to another
• Drop your Medicare Advantage plan and return to Original Medicare (Parts A & B) – but it’s important to check whether you can secure a Medicare Supplement (Medigap) policy first, since Medigap enrollment is not guaranteed and may require medical underwriting.
• If you return to Original Medicare, you can also enroll in a stand-alone Medicare Part D prescription drug plan

What You Cannot Do During MAOEP

• You cannot enroll in Medicare Advantage for the first time
• You cannot switch stand-alone Part D plans unless you first leave Medicare Advantage
• You can only make one change during this period

Why This Matters

Many people discover after January 1 that:

• Their doctors are no longer in-network
• Prescription drug costs are higher than expected
• Referrals or prior authorizations are more restrictive

MAOEP is designed to give you a second chance to adjust if your plan is not a good fit.

Get Free, Unbiased Help

If you live in Santa Clara County, HICAP offers free and confidential Medicare counseling. Our trained counselors can help you:

• Compare Medicare Advantage plans
• Understand costs, networks, and drug coverage
• Decide whether Original Medicare may be a better option for you

Contact HICAP today to schedule an appointment and make an informed decision about your Medicare coverage.

Call our Appointment Hotline at (408) 350-3288, or visit our Appointments page to view available in-person counseling sites throughout Santa Clara County.

This project was supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $432,451.00 with 100 percent funding by ACL/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by ACL/HHS, or the U.S. Government. Support provided by the California Department of Aging.

If you did not sign up for Medicare Part A and/or Part B when you were first eligible, you may still have another opportunity. This is called the Medicare General Enrollment Period (GEP).

When is the General Enrollment Period?

The GEP takes place January 1 through March 31 each year. Coverage begins the first day of the month after you enroll.

Who Is GEP For?

GEP is for people who:

1. Did not sign up for Medicare Part A and/or Part B when first eligible and
2. Do not qualify for a Special Enrollment Period (SEP)

What Can You Enroll In During GEP?

During GEP, you can:

• Enroll in Medicare Part A (if you must pay a premium)
• Enroll in Medicare Part B

After enrolling in Parts A and B, you can also:

• Join a Medicare Advantage plan, or
• Enroll in a stand-alone Medicare Part D prescription drug plan

Important Things to Know

• Late enrollment penalties may apply
• Penalties usually last for as long as you have Medicare
• Coverage does not start immediately, so timing is important

Why Counseling Is Important

Medicare enrollment rules can be confusing, and mistakes can be costly. Before enrolling, it’s important to understand:

• Whether you qualify for a Special Enrollment Period instead
• How penalties may affect your long-term costs
• Which coverage option best fits your health and budget

Free Medicare Help in Santa Clara County

HICAP provides free, unbiased Medicare counseling to Santa Clara County residents. Our counselors can:

• Explain your enrollment options
• Help you avoid unnecessary penalties
• Assist with plan comparisons after you enroll

Contact HICAP today to schedule an appointment and make an informed decision about your Medicare coverage.

Call our Appointment Hotline at (408) 350-3288, or visit our Appointments page to view available in-person counseling sites throughout Santa Clara County.

This project was supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $432,451.00 with 100 percent funding by ACL/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by ACL/HHS, or the U.S. Government. Support provided by the California Department of Aging.

Medicare’s Annual Enrollment Period (AEP) is right around the corner! From October 15 through December 7, 2025, Medicare beneficiaries can review their current health and drug coverage and make changes for the 2026 plan year. Any changes you make will take effect on January 1, 2026. 

What changes can you make during AEP? 

• During this time, you can: Enroll in, switch, or drop a Medicare Part D prescription drug plan.
• Join, switch, or drop* a Medicare Advantage plan (Part C), which may include extra benefits like vision, dental, or hearing.
• *Return to Original Medicare and, if you choose, add a stand-alone Part D plan. Look into the purchase of a Medigap supplement to cover the Original Medicare out- of-pocket costs, which could add up without extra coverage. 

You can make multiple changes, but only your last choice will take effect in January. 

Why review your coverage? 

Even if you’re happy with your current plan, it’s important to review your options every year. Plans can change their premiums, benefits, provider networks, and prescription drug formularies—or even terminate and leave the service area. New plans may also become available. Reviewing ensures that: 

• Your plan will still be available in 2026.
• Your doctors and pharmacies are still in-network. 
• Your medications are still covered at the best price. 
• Your total costs (premiums, deductibles, copays) still fit your budget. 

Look for your plan’s Annual Notice of Change (ANOC) and Evidence of Coverage (EOC), which arrive each September. These notices explain what’s changing for the new year. 

How HICAP can help 

The Sourcewise Health Insurance Counseling & Advocacy Program (HICAP) is Santa Clara County’s free, unbiased Medicare resource. Our trained counselors can: 

• Review your coverage and explain plan changes. 
• Use the medicare.gov Plan Finder to compare Part D and Advantage plans. 
• Help you apply for programs like Extra Help (which lowers drug costs) and Medi-Cal if you qualify.

Appointments are available by phone, video, and in person at community centers and libraries throughout the county. View our HICAP counseling locations here. 

Protect yourself from scams 

Medicare has strict rules about marketing. Plans cannot call you, email you, or show up at your home without your permission. Be cautious if someone pressures you into enrolling. If you suspect fraud, errors, or abuse, contact your local Senior Medicare Patrol (SMP) through Sourcewise. Don’t forget, Medicare, Social Security Administration, and Social Services will not call asking for your information. Call their real number if you are not sure about who is calling you. 

Get started today 

Don’t wait until the last week of AEP—review your options early. Call HICAP’s appointment hotline at (408) 350-3288 to schedule an appointment with a HICAP counselor. You can also view our Medicare AEP presentations on Zoom or at community locations. Visit mysourcewise.com/calendar for details. 

With support from HICAP, you can feel confident that your 2026 Medicare coverage works best for you. 

Every year, National Volunteer Week serves as a reminder to recognize and celebrate the generous contributions of volunteers in the community. At Sourcewise, volunteers enable us to expand our reach in the community allowing us to serve as many clients as possible. This year, National Volunteer Week falls from April 20 through 26, so join us in highlighting two of our most faithful and consistent volunteers: Abe and Jan Wischnia.  

The Wischnias have been registered volunteer counselors with the Health Insurance Counseling & Advocacy Program (HICAP) by Sourcewise since 2016. Each HICAP volunteer counselor undergoes extensive training to understand the intricacies of the Medicare ecosystem and is an essential resource to all Medicare beneficiaries, their family members, and advocates. Every counselor commits to a minimum of 40 hours of service a year, with hours drawn from a variety of activities ranging from 1:1 counseling appointments, Medicare presentations, and more.  

Part of what makes each volunteer such a vibrant addition to Sourcewise is the rich background and unique perspective they bring with them. For Jan, volunteering her time as a HICAP counselor followed as a natural progression of her career in social and healthcare services for older adults. She initially learned about HICAP when a counselor would provide annual presentations at the continuing care retirement community she worked at, and over time through cultivating a relationship with the counselor she grew an appreciation for the gap in Medicare understanding that HICAP filled.  For her husband Abe, his interest stemmed from his own struggle to understand Medicare when it came time for him to enroll.  

Jan and Abe have witnessed firsthand in their own lives and with their clients the need for HICAP services. They noticed that many older adults make Medicare decisions based on misleading advertising and well-intentioned misinformation from friends and online sources. Beyond that, they also observed a general dearth of knowledge many retirees have concerning Medicare. 

From April 2024 through April 2025 alone, Jan has donated 279 hours of service and Abe has donated 192. As every HICAP appointment can last up to an hour, that’s hundreds of appointments!

We hear all the time how thankful Sourcewise clients are for services like HICAP that provide essential information for free to empower anyone, regardless of income, to take charge of their health and future. This National Volunteer Week and every week we are so thankful for individuals like the Wischnias who choose to invest their time and energy back into the community. Every individual who chooses to volunteer not only makes an invaluable impact on our organization, but in the life of each client we serve.  

If you’re eligible for Medicare, whether you enroll in it or not, COBRA insurance can still affect you. But what exactly is COBRA? The Consolidated Omnibus Budget Reconciliation Act (COBRA) is a federal law that allows you to keep your employer health benefits after job loss, divorce, or death. Employers of a certain size must offer you COBRA when you retire or leave a job, continuing the same health coverage you had while employed. However, the payment rules for these benefits change if you’re eligible for both COBRA and Medicare after leaving your job.

Paying Primary Amounts, Paying Secondary Amounts, and Who Knows What in Between.

When you are enrolled in both COBRA and some Part of Medicare, COBRA benefits are designed to be secondary to those Medicare Parts. The rules are not as clear, however, when one has COBRA and Medicare Part A, but not Medicare Part B. How might one get in this situation? Since Medicare allows eight months to join Part B once you retiree, someone who elects COBRA might forget to sign up, or they think they can use Medicare Part A and COBRA, like they had been doing as an active employee, delay Part B Premiums, and assume COBRA will pay primary for their Part B type services, like doctor visits. This may or may not be true.

Some Employers/Carriers may in fact instruct more fortunate employees not to enroll in Part B as they are happy to take the Primary Payer Position for Part B type services. Other Employers/Carriers may not say anything. And unfortunately for some, their COBRA carriers insisted on secondary status based on mere Medicare eligibility after the fact. If a COBRA carrier thinks it mistakenly paid benefits that Medicare Part B could have covered, they may pull back the primary payment made to your doctor or other Part B type service provider and insist that you pay the primary amount. In some cases, amounts reached tens of thousands of dollars in charges. Surprisingly, the COBRA carrier insists on paying a lower secondary amount for such Part B type services despite receiving the same premium when the active employee’s Group Health Plan was primary.  Contrast this with a more reasonable situation where a retired Medicare beneficiary with Federal Employee Health Benefits (FEHB) has Part A but not Part B. Doctor services (normally covered under Part B), would be covered to the full extent allowed by a retiree FEHB plan, not as a secondary amount.

Now let’s talk about when you can keep COBRA with Medicare. It’s about the timing, but please remember failing to sign up for Medicare Part B within eight months of leaving your job could result in a permanent late Part B enrollment penalty, even if you have COBRA coverage remaining.

Here are the timing rules:

• If you’re on Medicare Part A or B, and the earliest entitlement date (i.e. effective date) precedes the date you elect or will elect COBRA, then you can continue with both. Any Medicare Part you are enrolled in would be primary to COBRA, and as mentioned above, a COBRA carrier may consider itself secondary to a Medicare Part that you do not yet have but are eligible for.
• If you’re on COBRA and then become eligible for Medicare, your COBRA benefits can be terminated by the employer.
• If you’re under 65 with Medicare due to End-Stage Renal Disease (ESRD), these rules do not apply.

Employer Group Health Insurance and Medicare: How They Work Together

If you or your spouse is still working and eligible for Medicare, here’s how your options look when your employer has at least 20 employees (for Medicare persons aged 65 and older) or 100 employees (for Medicare persons with disabilities):

1. Delay Medicare Enrollment: Continue using your (or your spouse’s) employer’s health plan benefits. Your benefits won’t change due to Medicare eligibility. You can enroll in Medicare later without a penalty if you do so within eight months after the month employment ends.
2. Enroll in Medicare and Keep Employer Insurance: Pay the Medicare Part B premium while retaining the employer’s health insurance. The employer’s plan while working will be primary, and Medicare can help cover additional costs like deductibles and copayments.
3. Opt for Medicare Only: Reject the employer coverage and use Medicare as your sole insurance. Employers can’t offer you supplementary medical coverage or coverage that is less than what is offered to non-Medicare eligible employees.

Leaving Employment: Transitioning to Medicare

When either you or your spouse stops working and employer health benefits end, you must enroll in Medicare Part B in a timely manner to avoid a late Part B penalty. Most people who have worked and paid Medicare taxes for 10 years likely signed up for Part A already. You would then decide on additional insurance available to you.

Your Options:

• Supplemental/Retiree Benefits: If offered by your employer, Medicare will pay first, and your retiree benefits may cover additional costs. Check if your retiree coverage includes prescription drugs; if not, apply for Medicare Part D.
• Medicare Part C Medicare Advantage or Part D with a Medigap to Supplement Original Part A/B coverage: Either of these two arrangements are available to Medicare beneficiaries. The plan pricing and options are based on where a person lives.
• COBRA Coverage: Extends your existing health benefits, but Medicare A or B pays first. COBRA requires paying the full premium, including the portion your employer previously covered, plus an administrative fee. Some employers may cover COBRA costs for a limited time after employment ends.

Important Considerations:

• Timely Enrollment: Enroll in Medicare within eight months after employer benefits end to avoid penalties and coverage gaps. Delayed enrollment in Medicare after starting COBRA can result in COBRA termination.
• Mistaken Payments: COBRA carriers may seek reimbursement for benefits paid that it thinks should have been covered by Medicare, where one has Part A, COBRA, but not Part B.

Assistance and Additional Options:

• Medigap Policy: Purchase this insurance to supplement Original or Traditional Medicare and manage its out-of-pocket cost risks. Do doctors take all Medigap Plans? Instead ask, “Does the doctor take Original Medicare?” If so, then any Medigap Plan will pay the doctor the out-of-pocket cost per the Medigap Plan standardized benefit.
• Medicare Advantage Plan (MA Plan): Private plans designed to lower Medicare’s costs by limiting your access to providers (stay in network) and services (requiring prior authorization). They may offer prescription drug coverage and some non-medical extras which might be good enough to make some overlook the above limits.  Check to make sure the providers you want to see, or continue to see, are in the network of the plan you are being sold.
• State Health Insurance Assistance Program (SHIP): Offers help with these choices. For instance, California’s SHIP is the Health Insurance Counseling and Advocacy Program (HICAP), available in every county.

Note: This information is general and may vary based on specific circumstances. It doesn’t cover scenarios where COBRA eligibility is due to factors unrelated to leaving employment.

This project was supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $1,923,099.00 with 100 percent funding by ACL/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by ACL/HHS, or the U.S. Government. Support provided by the California Department of Aging.

CA Health Insurance Counseling & Advocacy Program (HICAP) 1.800.434.0222

On May 8, 2024, Roxann, a 77-year-old woman living in San Jose, California, suffered a fall resulting in a broken hip which left her bed-bound and in urgent need of comprehensive support. Roxy’s situation was further complicated by malnutrition, an unmanageable living environment, and the need for a colostomy bag,

Thankfully, a Registry Specialist from Public Authority Services by Sourcewise (Public Authority) and a Case Manager from Ability Path realized Roxy’s situation and referred her to the Care Coaching Program and the On-Call Registry. This led to a coordinated effort between the Registry Manager, Care Coordinator, and On-Call Registry staff to conduct an initial home visit to assess her situation and identify areas needing improvement to which they found Roxy’s living conditions in a dire state. Her two-bedroom, one-bathroom home had become almost uninhabitable due to clutter and lack of cleanliness, which restricted access to needed areas such as the kitchen, living room, restroom, and bedroom.

The On-Call Registry by Sourcewise provided temporary care providers and assisted in increasing Roxy’s Back-Up Provider Service (BUPS) hours from 80 to 160, with the approval from her IHSS Social Worker, ensuring that she received the necessary support beyond regular hours. Eventually, Roxy was matched with a full-time Independent Provider through the Regular Registry, who assisted with personal care and helped create a safe, clean, and functional living space.

The Independent Care Provider from the Regular Registry went above and beyond by undertaking a thorough deep cleaning of Roxy’s house. They removed 37 large trash bags of clutter, requiring three pick-up routines, the bed was re-positioned to better accommodate her adaptive equipment, and the home furniture were rearranged for safer traversing. Additionally, her restroom and kitchen received deep cleaning, and her refrigerator was stocked with fresh food.

These changes enabled her to have proper meals, use the restroom, take warm showers, and prepare healthy meals. Roxy can now get dressed, roam around in her home with an electric wheelchair, and enjoy a stroll in her neighborhood, wearing sunglasses with a big smile. All thanks to the combined efforts of the Registry Manager, On-Call, and Care Coaching Programs at the Public Authority, IHSS Social Worker, and Case Manager from Ability Path who contributed to the transformation of Roxy’s mental state, well-being, and living environment to become a functional, welcoming, and habitable space.

Roxy’s story demonstrates how the act of joined efforts from organizations like the Public Authority, IHSS, and Ability Path can transform lives and foster independence. These collaborative efforts ensured Roxy’s recovery and highlights the value these organizations bring to the community of Santa Clara County.

In February 2024, Jeronima, a 61-year-old Latina residing in San Jose, California, faced a life-altering illness that left her bedbound and in need of immediate support. Referred to Public Authority Services by Sourcewise (Public Authority) through Adult Protective Services, Jeronima’s condition, including Muscular Dystrophy and memory loss, severely impacted her mobility and made her daily life unmanageable.

To address her needs, Jeronima was enrolled in the Care Coaching program at the Public Authority. The Registry Manager, Angelina Soria, along with Care Coordinators, conducted an initial home visit to assess her situation. They evaluated her home environment and identified areas requiring improvement. The On-Call Registry provided several care providers and facilitated an increase in Backup Provider System (BUPS) hours from 80 to 160, with approval from Jeronima’s IHSS Social Worker. This increase ensured that she received the necessary support even after her regular authorized hours. Ultimately, Jeronima was matched with a full-time Independent Provider through the Registry, who assisted with personal care and helped create a safe and functional living space.

Jeronima’s living conditions were initially challenging. She lived in a two-bedroom, two-bath condo but was bed bound due to Muscular Dystrophy, with limited mobility. Despite having functional hands, she struggled with short-term memory loss and had accumulated excessive items, restricting access to essential areas like the kitchen, living room, and restroom.

Recognizing the need for further assistance, Jeronima was referred to the Home Beautification and Intergenerational Activities program by Sourcewise. This program played a crucial role in transforming her living space. Seventeen boxes of clutter were removed, her bed was re-positioned to better accommodate her adaptive equipment, and living room furniture was rearranged for safer maneuverability. Additionally, her bathroom received a deep cleaning, and her kitchen cabinets were organized to make everything within easy reach. Her refrigerator was stocked with food as she applied for CalFresh, and the patio was cleaned with a lock installed on the sliding door.

The combined efforts of the IHSS Social Worker, Adult Protective Services, and the Care Coaching Program at Public Authority created a functional and welcoming environment for Jeronima. These changes brought her renewed joy and independence. She now enthusiastically greets visitors, can get out of bed, ride her electric wheelchair, and engage with her community. Jeronima enjoys activities like visiting the swimming pool and socializing with neighbors, all thanks to the support and resources provided by these dedicated organizations.

The story of Jeronima showcases the profound impact of coordinated community efforts, illustrating how support from the IHSS Social Worker, Adult Protective Services, and the Care Coaching Program at Public Authority can transform lives and foster independence.

A 2018 report indicated that around 1 million individuals aged 65 or older were living with substance abuse disorders. Overcoming substance abuse disorder is a demanding process, requiring significant effort to achieve and maintain sobriety. Therefore, preventing the disorder in the first place should be a top priority. Medicare offers several preventative services that can help address substance abuse both before it starts and after the impact of substance use.

Alcohol Misuse Screenings & Counseling

Medicare Part B covers alcohol misuse screenings and counseling for adults once per year. However, this service is classified as preventative care, so individuals who are medically diagnosed as alcohol dependent are not eligible. If a primary care doctor or another healthcare provider determines that an individual is misusing alcohol, they can receive up to four short face-to-face counseling sessions per year. These sessions are free of cost if the healthcare provider accepts Medicare. Both screenings and counseling occur in primary care settings, such as a doctor’s office.

Hepatitis C Screening

Hepatitis C screening is covered by Medicare if ordered by a primary care doctor or another healthcare provider when specific conditions are met. These conditions include:

• Having had blood transfusions before 1992
• Being born between 1945 and 1965
• Having a history of illicit drug injection

If an individual born between 1945 and 1965 does not have a high-risk history (such as illicit drug injection), Medicare will cover one screening. For those at considerable risk, Medicare will cover annual screenings.