What’s the Difference Between Home Health Care and At-Home Care?
Dear Toni,
I need your help regarding my parents. They’re both in their late 80s. My mother has been disabled with Parkinson’s for the past 3 years, and my father has been her caretaker. Sadly, due to his recent heart attack, he can no longer assist her.
Unfortunately, they don’t have a long-term care plan, and discussing having live-in help or living in an assisted living facility is out of the question. My parents’ big worry is that they will outlive their retirement money and be unable to provide financially for themselves. My concern is that my parents cannot properly take care of themselves and that something serious could happen to them living on their own.
What is the difference between home health care and at-home care? Will Medicare pay for at-home care?
Thanks in advance,
Theresa from San Diego, CA
Hi Theresa,
Don’t feel like you’re alone with this problem of aging parents. As a matter of fact, many baby boomers are experiencing just what you’re facing. Elderly parents don’t want to lose their independence by not controlling their finances. This kind of situation is challenging when they can no longer care for themselves properly.
I faced the same stressful issue with my mother. I discussed different options with a home health agency representative, who explained how to maximize my mother’s Medicare dollars with home health care benefits, not at-home care.
Home Health Care
To receive home health care services from Original Medicare (not a Medicare Advantage Plan):
- There must be a medical need to receive Medicare-certified home health care services.
- Primary care or specialists must order home health care services.
- The Medicare beneficiary must need intermittent skilled nursing care, and physical, speech, or occupational therapy.
- The home health agency must be Medicare-certified. (Note: If they’re not Medicare-certified, you pay 100% of the home health charges.)
- The Medicare beneficiary must be homebound. (“Homebound” means not leaving home without help from someone or aid from a wheelchair, walker, cane, etc. due to illness or injury.)
Once these conditions are met, Original Medicare will cover the types of care listed below:
- Skilled nursing care, performed by a licensed caregiver.
- Home health aide care to assist in bathing, dressing, and other personal care that must be part of the health care for illness or injury.
- Physical, speech, or occupational therapy.
With “Original” Medicare, there is no co-pay or deductible for home health care. Additionally, Medicare will pay 100% for any medical services provided by a home healthcare agency that accepts Medicare assignments.
Those with “Original” Medicare, not Medicare Advantage plans, have “patient’s rights” with the right to choose which home health care agency to use. Those enrolled in a Medicare Advantage plan must use network providers and can limit how much home health care one receives. Make sure you understand the difference in benefits carefully!
Under Original Medicare or a Medicare Advantage plan, the time spent at home with the patient for home health care is limited to part-time or intermittent. Neither will pay for help with daily at-home care of the patient once the medical need is taken care of that day.
Page 43 of the 2025 Medicare & You Handbook states: “Part-time or intermittent means you may be able to get skilled nursing care and home health aide services if they’re provided less than 8 hours each day or less than 28 hours each week (or up to 35 hours a week in some limited situations).”
At-Home Care
At-home care is not a Medicare option. Instead, you must pay for it with your money. “At-home care” is a non-medical, in-home care for the patient in support of aging while at home. Theresa, it would help you and your parents to build a long-term care needs plan ranging from a few hours a day to 24-hour care.
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Originally published December 27, 2024
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