When considering home care services for a loved one, financial concerns are often top of mind. One common question that arises is - does Medicare pay for Visiting Angels.

Understanding the nuances of Medicare coverage for home care can help you navigate this decision and ensure that your loved one receives the care they need.

What Medicare Covers for Home Care

Medicare, the federal health insurance program for those 65 and older, provides coverage for a range of medical services. However, its support for home care services is quite specific. Medicare will only cover home care if it is deemed medically necessary and prescribed by a doctor.

Here’s a detailed look at what Medicare may cover:

1. Short-Term Home Health Care

Freepik | DC Studio | Medicare may cover short-term home health care needed after a hospital stay if recovery is expected.

Medicare might cover short-term home health care if the care is needed following a hospital stay or medical treatment from which the patient is expected to recover. To qualify, the following conditions must be met:

• The patient must have been hospitalized for at least three days.
• Care must be provided by a Medicare-approved agency within 30 days of the hospital stay.
• A physician must certify that skilled care, such as physical therapy or skilled nursing, is required.

For eligible patients, Medicare covers 100% of the costs for the first 20 days. From day 21 to day 100, Medicare covers a portion of the costs, with the patient responsible for the remaining expenses. After 100 days, all costs are borne by the patient.

2. Doctor-Prescribed Recovery Care

Medicare may also cover additional home care services if a doctor determines they are necessary for recovery from an injury or illness. This can include:

• Part-time nursing care.
• Physical therapy, occupational therapy, or speech therapy.
• Medical social services to address psychological or social issues.
• Medical supplies such as wheelchairs or oxygen services.

There is no specific limit on how long these services can be covered, as long as the doctor continues to prescribe them and reorders them every 60 days. The patient must also be certified as homebound to receive these services.

3. Hospice Care

For patients with terminal illnesses, Medicare provides comprehensive hospice care coverage. This care can be received at home, a nursing home, or a hospice facility and includes:

• Medical and nursing care.
• Physical and occupational therapy.
• Medical equipment and supplies.
• Prescription drugs for symptom control.
• Hospice aide and homemaker services.
• Grief counseling for the patient and family.
• Social work services.
• Short-term inpatient care for pain management.

Once Medicare starts funding hospice care, it will no longer cover other treatments aimed at curing the illness. The patient or their representative must sign a statement confirming the choice of hospice care. Medicare will cover all hospice care costs, minus a copay for prescription drugs and a small copay for inpatient respite care.

Does Medicare Pay for Visiting Angels?

Freepik | DC Studio | Medicare typically covers only medically necessary services from approved home health agencies.

The question of whether Medicare covers services from Visiting Angels (an agency specializing in home care services ) depends on the nature of the care required. Medicare generally covers only medically necessary services provided by Medicare-approved home health agencies. Visiting Angels is not typically a Medicare-approved provider, which means that standard home care services provided by them may not be covered by Medicare.

For those needing help with long-term personal care or non-medical services such as assistance with daily living activities, Medicare coverage is limited. These services often include help with bathing, dressing, or mobility, which are not covered under Medicare.

Alternatives to Medicare Coverage

If Medicare doesn’t cover the home care services needed, there are other options to consider:

• State Medicaid Programs - Medicaid may offer coverage for home care services based on income and other eligibility criteria.
• Veterans’ Affairs Benefits - Veterans and their families may be eligible for additional support through veterans' benefits programs.
• Long-Term Care Insurance - Private insurance plans might cover home care services not covered by Medicare.

Understanding these options can help families find the necessary financial support to ensure quality care for their loved ones.

While Medicare provides valuable coverage for certain types of home health care, it does not generally cover services from Visiting Angels unless the care is provided under specific, Medicare-approved conditions. Exploring alternative funding sources or insurance options might be necessary to cover the full spectrum of home care needs.