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Home Health Care and What Medicare Will Pay For

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Toni explains the difference between Home Health Care and Care At Home – what will Medicare pay for? What is the best plan when taking care of someone in need of care? Toni explains what legal paperwork is best to have prepared in advance. 

Home Health Care and What Medicare Will Pay For

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Navigating the complexities of health care can be daunting. Understanding what services are covered by Medicare can help ensure that you or your loved ones receive the necessary care without undue financial stress. Let’s explore the specifics of home health care, how it differs from at-home care, and what Medicare will cover.


What is Home Care?

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Home care encompasses a range of services to assist seniors in their daily lives. These services are typically non-medical and include assistance with activities such as bathing, dressing, meal preparation, and housekeeping. Home care is designed to help individuals maintain their independence and live comfortably in their own homes.

What to Remember About Home Care:

  • It’s Non-Medical Assistance: Home care provides support with everyday tasks.
  • Independence: Aims to help seniors remain in their homes.
  • Paid Out-of-Pocket: Generally not covered by Medicare and is paid for by the individual or through long-term care insurance.

What is Home Health Care?

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Home health care, on the other hand, includes medical services provided by licensed professionals. This care is often prescribed by a physician and is intended for those who are recovering from an illness, injury, or surgery. Services can include skilled nursing care, physical therapy, occupational therapy, and speech therapy.

What to Remember About Home Health Care:

  • Medical Services: Includes nursing care and various therapies.
  • Physician Prescribed: Must be ordered by a healthcare provider.
  • Medicare Coverage: Often covered by Medicare, but specific conditions must be met.

What Will Medicare Pay For?

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When it comes to home health care, Medicare offers substantial coverage, but there are important details to understand:

Medicare Coverage for Home Health Care

Eligibility Requirements:

  • A physician must certify that you need intermittent skilled nursing care, physical therapy, speech-language pathology, or continued occupational therapy.
  • You must be homebound, meaning leaving home is a major effort and requires assistance.
  • Care must be provided by a Medicare-certified home health agency.

Services Covered:

  • Skilled Nursing Care: Intermittent care provided by or under the supervision of a registered nurse.
  • Therapies: Physical, occupational, and speech-language therapy.
  • Home Health Aide Services: Part-time or intermittent services to help with personal care, such as bathing and dressing.
  • Medical Social Services: Services ordered by a physician to help with social and emotional concerns related to a medical condition.


Should I Get a Medicare Advantage Plan?

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Medicare Advantage Plans, also known as Part C, are offered by private companies approved by Medicare. These plans must cover all the services Original Medicare covers, but they can have different rules, costs, and restrictions. Here are some things to consider:


Pros and Cons:


  • May offer additional benefits, such as vision, hearing, dental, and wellness programs.
  • Can provide more coordinated care through plan networks.


  • You may be restricted to using a network of doctors and hospitals.
  • Some plans may have higher out-of-pocket costs than Original Medicare.


  • Compare Plans: Use the Medicare Plan Finder to compare the benefits and costs of different Medicare Advantage Plans in your area.
  • Check Networks: Ensure your preferred doctors and hospitals are in the plan’s network.
  • Understand Costs: Look at premiums, deductibles, and other out-of-pocket costs.

What Else Should I Know?

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Understanding Medicare and how it applies to home health care and at-home care can be challenging. Here are some additional tips to help you navigate the process:

Stay Informed

  • Regular Reviews: Periodically review your Medicare coverage to ensure it meets your current needs.
  • Ask Questions: Don’t hesitate to ask questions if you’re unsure about coverage details or services.

Plan Ahead

  • Legal Documents: Ensure you have essential legal documents in place, such as a durable power of attorney, living will, and healthcare proxy.
  • Long-Term Care Plan: Consider developing a long-term care plan that includes financial and caregiving arrangements.

Get Support

  • Professional Advice: Consult with Medicare experts or a health care advisor to better understand your options.
  • Community Resources: Utilize local resources, such as senior centers and support groups, for additional information and assistance.

The Bottom Line on Home Health Care and Medicare

I remember helping my own mother navigate her options when she needed home health care. It wasn’t easy, but understanding the coverage and having the right documents in place made a huge difference. Take the time now to prepare and ensure you have all the necessary information.

Remember, Medicare covers essential home health services, but planning ahead and staying informed are key to maximizing the benefits available to you.

For personalized assistance with your Medicare questions, reach out to Toni King, America’s Medicare expert, at 832-519-8664. Ensure you or your loved ones receive the care and support needed to live comfortably and independently at home.


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Originally published May 24, 2024


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