5 Things To Consider When Integrating Your Home Health Care With Medicare

Medicare can be perplexing, all the more so when you combine complex health issues and the need for medical aids such as oxygen or hospital beds. While the insurance maze can be difficult to traverse, an estimated 47.5 million people received this program in 2010, which is more than a sixth of the nation’s population.

Here is a brief overview and some answers to some commonly asked questions regarding Medicare and home health care.

1. Who qualifies?

Medicare is a national health insurance program provided by the U.S. government for those who are:

- 65 and older

- Under 65 with certain disabilities

- Diagnosed with End Stage Renal Disease (ESRD), a form of permanent kidney failure requiring dialysis or a kidney transplant

2. What types of services does Medicare cover?

Medicare has four different coverage sections: Part A, B, C, and D. “Original Medicare” consists of Part A & B, while Part C is known as “Medicare Advantage Plan”. These four parts are summarized briefly:

- Medicare Part A: Hospital Insurance

* Part A covers care while in hospital as well as health care in skilled nursing facilities, home health care, and hospice.

- Medicare Part B: Medical Insurance

* Part B covers doctor’s visits as well as visits to other health care providers. Additionally, Part B covers hospital outpatient care, durable medical equipment (like intravenous infusion devices), and home health care services. Part B also covers specific types of preventative services, such as getting certain vaccinations.

- Medicare Part C: Medicare Advantage

* Part C combines health plan options you purchase from other private insurance companies approved by Medicare. Part C also integrates Medicare Prescription drug coverage (Part D) and can be tailored to include extra benefits at an extra cost.

- Medicare Part D: Medicare Prescription Drug Coverage

* Part D covers the prescription of Medicare-approved prescription drugs and can lower the cost of other medications. Similar to Part C, Medicare-approved private insurance companies also run Part D.

3. Why do I need to choose between Medicare plans?

The choice of “Original Medicare” (Parts A & B) entails payment of monthly premiums for part B and may necessitate additional coverage to pay deductibles and coinsurance to see physicians, hospitals, and other providers who accept Medicare. If you require Prescription drug coverage, you must pay a monthly premium to join the Medicare Prescription Drug Plan (Part D).

The “Medicare Advantage Plan” (Part C, which covers Part A & B), also requires the payment of monthly premiums in addition to the Part B premium & a copayment for in-plan doctors, hospitals. If prescription medications are not covered by your supplemental coverage, you have the option of joining the Medicare Prescription Drug Plan (Part D).

As with prescription medications, you can purchase supplemental coverage to cover services not covered by Medicare. The “Original Medicare” plan allows for the option of buying Medicare Supplement Insurance (Medigap), while the “Medicare Advantage Plan” does not.

It is prudent to always check if you can take advantage of other additional coverage through your employer or union, military, or Veteran’s benefits.

4. Is home health care covered by Medicare?

The Medicare website states, “Medicare only covers home health care on a limited basis as ordered by your doctor”. As reviewed earlier, Parts A & B are the Medicare options which cover the home health care services specified by Medicare.

Coverage of home health care by Medicare in New Mexico stipulates you must meet the following criteria:

- You are currently receiving regular services from a physician. This physician must also maintain a care plan unique to you, which is reviewed regularly.

- Your physician must certify a “need” for specific medical services such as requirements for intravenous medication therapy, physical therapy, occupational therapy, respiratory therapy, or speech-language pathology services.

- The home health care agency providing you services must be Medicare-certified (for more details see below).

- Your physician must certify your health status as homebound, which is indicated by the following:

* Your health condition limits you from leaving the house.

* You are unable travel from home without help (i.e. transportation assistance such as aids or individuals).

* Leaving your home takes considerable effort and may be detrimental to your health condition.

5. My home health company does not take Medicare, why is this?

The Medicare-approval process is lengthy and costly, so while it may appear that many companies may not take Medicare, they may actually be in the process of becoming Medicare certified.

Furthermore, the Medicare criteria for individual qualifying to receive home health care are very strict; the reality is that many people who may apply for coverage by Medicare for their approved home health company services will not actually receive coverage. Currently, Medicare pays only about half of all health care costs to seniors. Medicare very often denies payment due to not meeting criteria, so it is essential to be aware if you meet these criteria prior to restricting yourself exclusively to Medicare-approved home health care companies.

Home Health Care vs Assisted Living

Home Health Care in Los Angeles

Home health care is health care that is provided to patients inside their home, and usually by either health care professionals or family and friends. The term “home care” suggests that the care provided is non-medical and more of a custodial nature, whereas “home health care” may suggest licensed staff members. The differences here are similar to the differences between assisted living facilities and nursing homes. Much like assisted living facilities, home health care lets seniors enjoy a good measure of independence. An elderly individual or couple will appreciate having privacy as well as assistance in daily living needs.

What Home Health Care Provides

What kind of services does home health care provide? Home health care may help seniors with daily living needs such as bathing, dressing, house keeping and cooking and dining preparation. Depending on the needs of the resident, there may be special provisions such as transportation services and errands, volunteer programs, exercise and walking, and toileting assistance. More extensive forms of home health care would also provide rehabilitation programs, including visits from physical therapists and nurses. Other qualified home health care professionals may include respiratory nurses, occupational nurses, social workers, mental health workers and physicians.

Who pays for home health care? This type of outside assisted living program can be paid by private resources from the resident or family, by public payers such as Medicare and Medicaid or by employer-sponsored health insurance plans. Medicare will usually not pay for home health care on a long term basis while Medicaid is more likely to help low-income families with little or no assets. Employer-sponsored home health care is likely to be on a short term basis unless the insurance plan is very generous. Most of the time home health care will be paid for by a family’s own resources.

Comparing Home Health Care with Assisted Living

How does home health care compare with in-house stays at nursing homes and assisted living facilities? Most seniors would prefer home health care, of course, as people always do value their privacy. However, there are also circumstances that would necessitate constant supervision of the resident at an assisted living facility, and not only occasional visits. Home health care is basically assisted living, but with even more independence. Therefore a resident that cannot be left alone for long periods of time would be better suited in a nursing or board and care type home.

It might appear that home health care would be cheaper than a stay in a nursing home. However, home health care costs can be just as expensive, depending on the number of hours aides work. Some residents have admitted that full time home health care usually costs twice as much as a stay in a board and care or assisted living home. Most home health care agencies will charge about $20.00 an hour or over. If the resident is relatively independent then the fees associated with the service can be controlled. However, don’t forget that if your needs are minimal to begin with, you could hire a trusted individual to perform the same tasks and save money from paying an agency fee.

Home health care is ideal for seniors who feel well and can easily get around but who need occasional doctor visits and help with housekeeping. It is also a preferable choice if a senior needs full time care but does not want to become a resident in a public nursing home. Full time home health care provides the most privacy and personal attention possible. If you are looking for this type of senior assistance, you should always be mindful of the qualifications of workers, as opening one’s home to a stranger could always be a security risk. The best home health care agencies have screened workers who are well qualified in their field.

How We Can Help You

ElderHomeFinders is a company dedicated to helping seniors locate assistance in the southern California area. We inspect assisted living facilities and retirement communities in the area so that our clients will find the perfect home at a price they can afford. Can ElderHomeFinders also help seniors find home health care? Yes. Our company can put you in touch with the right home health care agency, according to your special needs and budget limitation. We can also advise you on the differences between home health care services and assisted living and board and care facilities and which choice would better work for you. Seniors have worked hard all their life and surely deserve the best health care possible – whether in a senior living facility or in their own home.

Home Health Care, an Alternative to Nursing Homes

More and more people are choosing home health care as an alternative to entering assisted living facilities. There are different levels of care available to individuals who wish to remain in their homes but who need a little extra help. Having these options make it possible for lots of folks to stay in their houses longer and live their own lives. There are several compelling reasons families are choosing this for their loved ones.

Better for the Well-Being of the Patient

Studies have shown that being allowed to stay at home and to maintain some level of independence is better for the patient’s overall health. Feeling “put away” can cause feelings of depression or hopelessness, which in turn may cause increased health problems. If a patient has a say in their own care, they feel much better and their body can recover and heal more efficiently. This is true even if they do decide to enter a nursing home, but simply having the option is a big help.

Comfortable and Convenient

When the time comes when someone needs a little special attention or care, it is important for them to be as comfortable as possible. A big change in their health condition is stressful enough. Sometimes, the best decision is to make sure they can stay in their own home where everything is familiar, so that there aren’t as many drastic changes all at once.

Not having to pack a bag or decide what can stay or go is another benefit to home health care. Everything is as it always was, but now there is someone there to help with the details.


The old stereotype about home health care is that it is not affordable except for the super-rich. This is not at all the case. An ever increasing number of health insurance providers are covering this type of care, and certain government programs can offer financial assistance.

Easier on Families

Home health care is a wonderful blessing for couples who need help for one person but not the other. The couple can stay together in their own home, but without the pressure of one person having to provide constant assistance to the other. The strain is off the partner, and the couple can simply enjoy being together. This also has health benefits for the partner.

Kids, grandkids, brothers and sisters might be helping out with the health care needs of an individual just so they can stay at home. With a home health care provider, the patient will receive professional assistance. The family members also benefit, because when they come to visit they can just spend quality time together instead of concerning themselves with all the health issues.

Home health care is a welcome option for many folks who are trying to decide how to plan for the future in light of their physical requirements. While a nursing home is still a very good option for many people, it is reassuring that there are choices out there to fit everyone’s individual needs.