What this page can and cannot tell you
Medicare rules are detailed, and they differ by plan and by the care a person needs. This page is general education, not coverage advice. Gateway does not decide what a plan will pay, and we cannot promise that any visit will be paid for or that you will owe nothing.
What we can do is help you ask the right questions. Gateway arranges primary care house calls with partner clinicians in Greater St. Louis and the Metro East, and we help sort out the practical steps around each visit. For a broader look at plan types, see our insurance questions page.
Two ways people have Medicare
Most people with Medicare are in one of two arrangements, and the questions are a little different for each.
- Original Medicare. Part A is hospital insurance and Part B is medical insurance. Part B generally applies to visits with physicians and other practitioners who are enrolled in Medicare. Deductibles and coinsurance generally apply, and many people add a supplemental policy.
- Medicare Advantage. A private plan that provides Medicare benefits. These plans often use networks, referrals or prior authorization, and the rules can differ from plan to plan and from year to year.
Medicaid is a separate program. In Missouri it is called MO HealthNet, and some people have both Medicare and Medicaid. Ask each plan what it requires.
Why a house call is not the same as an office visit to a plan
A house call is still primary care. The clinician reviews your health, your conditions and your medications. What changes is the place of service, and some plans have their own rules for visits that take place at home.
Plans may ask whether the person has trouble leaving home, whether the visit is medically necessary in the treating clinician’s judgment, and whether the practice is enrolled and participating. Our guide on what homebound means explains how that word is used, because it matters more for some programs than others.
Who may visit
Visiting clinicians who see patients through Gateway may be physicians, podiatrists (DPM), nurse practitioners or nurses, matched to the patient’s needs. The treating clinician decides what each visit includes.
Preventive visits under Medicare
Medicare generally offers an annual wellness visit, which is a planning visit and is not the same as a physical exam. Some people have it at home. Read about the annual wellness visit at home and the guide to what it includes to see how it differs from an ordinary problem-focused visit.
If you have two or more long-term conditions, you can also ask whether chronic care management is offered. Plans and programs set their own rules, including patient consent and possible cost sharing.
Questions to ask before the first visit
Keep a notepad by the phone and write down names and dates. These questions work for most people.
- Which practice will see me, and are its clinicians enrolled in Medicare and participating with my plan?
- Does my plan require a referral or prior authorization for visits at home?
- What might I owe for a visit, such as a deductible or coinsurance, and could a supplemental policy help?
- Are lab work, imaging or equipment ordered during a visit handled differently?
- Who is responsible for billing questions, and how do I reach them?
Note the date and the name of each person you speak with. The same approach works for wounds: see Medicare and wound care questions to ask.
How Gateway helps
Call 314-325-0126 or send a request for care. The form asks only for your name and phone number, so please leave out medical details. We ask about your address, your care setting and your plan type, confirm whether a partner clinician is available for your location, and tell you which practice would see you so you can check participation with your plan.
You do not need a referral to call. Family members and caregivers can call for someone else.
When to get help urgently
House calls are planned care and Gateway is not an emergency service. Call 911 for chest pain, trouble breathing, signs of a stroke, severe bleeding or sudden confusion. For other concerns between visits, call the treating clinician’s office.
Common questions
Does Medicare pay for a primary care house call?
It depends on the treating provider, your plan and your circumstances, so no one can answer in general terms. Original Medicare Part B may apply to visits with enrolled clinicians, and Medicare Advantage plans set their own rules. Ask the practice and your plan before the first visit.
Do I need to be homebound?
Not to contact Gateway. Some programs and plans use homebound status in their own rules, and others do not. Describe how hard it is for you to leave home, and the practice and your plan will tell you what applies.
Will I owe a copay or coinsurance?
You may. Deductibles, copays and coinsurance depend on your plan and the services provided. A supplemental policy may change what you owe. Ask for an estimate from the plan and the practice before the visit, and keep any statements you receive.
What if I have Medicare Advantage?
Check whether the plan requires a referral, a network clinician or prior authorization for visits at home. Call the member number on your card and ask directly. You can also tell Gateway which plan you have when you call.
Can my family member call the plan with me?
Yes, if you give permission. Plans often need you on the line to confirm identity, and some allow you to name an authorized representative. Ask the plan how to set that up.