How to Pay for Home Health Care (skilled) and Home Care (non-skilled)?

To protect yourself and your family from unnecessary expense, ask questions and be sure you understand the reason your doctor prescribes specific services and whether or not they are covered
How to Pay for Home Health Care (skilled) and Home Care (non-skilled)

If you are planning ahead for the time when you might need Home Health Care services or are searching for those services for a family member, you will be asking these questions: “What is the average cost of Home Health Care services?”, and “What factors affect the cost?”. You will be looking for answers about how much Medicare and Medicaid might pay and what other sources of help are available.

Sometimes, people need Home Care services but not Home Health Care services. It is important to know the difference in the two types of care.

The following things are true about Home Health Care services:

  • They must be prescribed by a physician
  • They are administered (or overseen) by a nurse (RN)
  • They may be administered by a home health aide, certified nursing assistant, or licensed vocational nurse under the supervision of an RN

Services available through Home Health Care include, but are not limited to:

  • Injections
  • IV infusions
  • Catheter care
  • Ventilator patient care
  • Tracheotomy care
  • Diabetes management teaching
  • Post-operative rehabilitation (physical, occupational, and speech therapy
  • Medication administration and pain management
  • Discharge planning and skilled assessments
  • Grief counseling and facilitating of support groups
  • Wound care and education on disease management
  • Durable medical equipment

Home Care Services include, but are not limited to:

  • Non-medical care services provided by caregivers
  • Assistance with ADLs (Activities of Daily Living) and personal care
  • Assistance with feeding, toileting, bathing, dressing, transferring, and ambulation
  • Help with ADLs like laundry, light housekeeping, errands, grocery shopping, medication reminders, meal planning, and companionship
  • Services by a Personal Care Assistant (PCA) include any hands-on care such as bathing and incontinence care
  • Companionship services including social outings, conversation, reading books, activities or hobbies, recreational activities or travel

Home Health Care services are used by people of any age with special needs but are most often used by older adults who wish to remain in their homes and live independently for as long as possible.

Medicare and Medicaid cover some of the costs of Home Health Care Services but do not cover non-medical home care services if that is all that is needed.

How to Pay for Home Health Care?

How to Pay for Home Health Care

What Affects the Cost of Home Health Care?

Home Health Care can involve both medical and non-medical care, but only if the medical aspect is primary. Times when a patient needs both medical and non-medical in-home care include after a stroke or a serious accident.

Home Health Care is performed by medical professionals and is intended for short-term delivery. The goal of Home Health Care is to help the individual improve their medical condition or prevent further deterioration.

Some factors influence the variation in Home Health Care costs. These include:

  • Cost of living: Areas with a higher cost of living (Massachusetts, Washington) tend to have higher Home Health rates
  • Type of area: Urban or rural area (Fewer providers in rural areas can mean higher prices)
  • The State’s minimum wage:¬†According to Forbes, if a company needs to have a $4/hour profit with a minimum wage of $15, the hourly rate would be $19

Paying for Home Health Care for the needed length of time can be a challenge for many patients and families. Some sources of funding are discussed below.

1. Medicare and Medicaid

1.1 Medicare

  • When a person meets certain requirements for eligibility, Medicare will cover skilled home health care on an intermittent basis. It must be determined by a doctor managing the case to be intermittent and for a limited length of time.
  • The doctor will then need to outline a plan of treatment and prescribe the necessary care.
  • The second requirement for Medicare coverage is that the patient must be homebound.
  • According to Fred Johnson, President and CEO of a national agency called Team Select Home Care, the person applying for services would need help getting out of bed.
  • It would have to be determined that the senior would not be able to safely get to a doctor’s office appointment or other therapeutic clinic without assistance.
  • If the senior citizen meets these criteria, Medicare will typically fully cover the services of a home health aide from a Medicare-certified home health agency with no deductibles charged.
  • Skilled nursing care, occupational therapy, physical therapy, wound care, speech-language therapists, and medical social workers services will also be covered.
  • Check with your Medicare policy before making a decision to find out about any possible out-of-pocket charges that may apply for certain services.

1.2 Medicaid

  • Medicaid benefits vary from state to state. Some states offer generous assistance with Home Health Care costs for people in low income brackets, while others do not.
  • One Medicaid program known as PACE (Programs of All-Inclusive Care for Elderly) offers dual eligibility for Medicare and Medicaid for seniors at least 55 years old who have low income and are in frail physical condition. Without this level of help, PACE recipients would need nursing home care.
  • With PACE benefits, individuals can attend adult day care, have meal delivery, nutritional counseling, physical therapy, and transportation services.
  • The PACE program is not available everywhere in the U.S., so consult your insurance provider to see if it is available where you live.
  • Be aware that once your physical condition improves and you no longer require Home Health Care, you will have to find other ways to pay for needed non-medical home care. Much of this care is paid by the individual, a family members, or long-term care insurance if applicable.

2. VA (Veteran’s Administration)

  • Veterans who receive their medical care from the Veteran’s Administration (VA), can access benefits that will assist in paying for in-home care.
  • The home health services would be based on the individual needs of each veteran.
  • A home health aide might visit for a few hours several times weekly to help with eating, bathing, dressing, personal grooming, and errands like shopping for groceries.
  • Online VA services are available that can help veterans make wise choices for their specific needs.

3. Tax Deductions for Medical Expenses

According to information from TaxCure professional tax preparer Kari Brummond, taxpayers are allowed to claim a tax deduction on medical costs that surpass 7.5% of their yearly adjusted gross income.

This deduction can help to counteract Home Health Care expenses.

4. Out of Pocket

Home Health Care services could be an overwhelming expense to have to pay out of pocket. There will inevitably be some residual out of pocket charges on items or services where Medicare only covers 20%.

Frequently Asked Questions About Paying for Home Health Care

1. Is home health care covered under Medicare Part A or B?

An individual who has Medicare Part A and/or Medicare Part B can receive some or all of their home health care coverage if they need specialized care that is expected to result in improvement in a predictable time and their needs cannot be met without specialized care.

2. Does Medicare Advantage cover Home Health care?

Some Medicare Advantage plans offer some home health care coverage. Check with your insurance agent to get details or what your Part C plan includes.

3. How much does Medicare pay for home health care per hour?

Medicare does not pay for home health care by the hour. A single payment is made to the agency to cover all care you receive during a 30-day period. (Some services are not covered, such as routine foot care). Multiple 30-day periods can be approved and paid, and your doctor will receive regular updates to help determine how long you will need services.

4. What home health care is covered by Medicare (which home health service is covered by Medicare)?

Medicare covers skilled nursing care, physical, occupational, and speech therapy, speech/language pathology services, intermittent or part-time services from a home health aide as long as it comes along with skilled care, medical social services, and 80% of medical supplies and durable medical equipment.

5. How many home health visits will Medicare cover?

There is no set number of visits, but it has the following limits. The visits must be less than 8 hours each and total 28 hours or fewer per week (except 35 hours in unusual circumstances).

6. How much does it cost for 24 hour home health care?

Medicare does not cover 24 hour home health care.

7. Does Medicare cover home health care after surgery?

Post-surgery care can be covered within the attending physician’s treatment plan and insurance plan specifications.

8. Does Humana health insurance pay for home health care?

As a Medigap plan (Medicare Supplement), Humana health insurance would not pay for home health care. Some Humana Medicare Advantage plans may help pay for home health care, so be sure to check with our insurance company for details.

9. How much does Medicaid pay for home health care per hour?

Medicaid does help pay for home health care in all 50 states, but the amount per hour and the way it is administered varies by state.

How to Pay for Home Care

How to Pay for Home Care

1. Private Out-of-Pocket

Paying out of pocket requires great care in researching and comparing different home care agencies. Learn all you can about each facility, as you will have difficult choices to make between affordability and quality.

2. Long Term Care Insurance

Anticipating future home care needs, many people choose to purchase a long term care insurance policy to help pay for services when needed.

Many people purchase a policy in their 50s or early 60s when they have access to lower premiums. Many people who are 65 or older develop medical conditions that require assistance, and if the long term care policy is in place, they do not have to deal with a waiting period before coverage begins.

Waiting periods might be typically between 30 and 120 days. There is a correlation between how long the policy is active and how long benefits will last. The typical benefit duration is from three to five year.

3. Private Medical Health Insurance

Home care benefits involving custodial and personal care services are usually not covered by private medical health insurance. Both private insurance policies and HMOs typically follow Medicare guidelines and only cover short-term, skilled, medically necessary services.

4. Cash and Counseling Programs

Cash and Counseling Programs are an example of consumer-directed care. A cash allowance is provided to the senior citizen for home care needs. The funds may go to hire a friend or relative to provide personal and household care or purchase assistive devices and necessary home modifications.

For more information on Cash and Counseling Programs, call the U.S. Administration on Aging at 1-800-677-1116 to access the Eldercare Locator.

Frequently Asked Questions About Paying for Home Care

Does Medicare Cover PCA Services?

No, Medicare does not cover PCA services unless they are combined with skilled care.

Will Medicare pay for home health aide?

Medicare will pay for a home health aide if skilled care is already in place.

Does Medicare cover companion care?

Medicare does not cover companion care.

Does Medicare pay for 24 hour home care or live-in caregivers?

No, Medicare does not pay for 24 hour home care or live-in caregivers. It only pays for short-term skilled care.

Does Medicare pay for private caregivers?

No, Medicare doesn’t pay for private caregivers.

Does Medicare cover non-medical/non-emergency transportation from hospital to home?

Medicare typically does not cover non-medical/non-emergency transportation from hospital to home.