Dear Toni: My mother, Doris, had a heart attack in February and was in the hospital for over a week, with a short stay in a skilled nursing facility. She needed additional care at home, and her cardiologist ordered home health with a nurse who comes to her assisted living facility only once a week for about 20 minutes.
I asked her cardiologist and manager of the assisted living facility to order a nurse or aide through her Medicare home health benefits for a minimum of an eight-hour daily stay. I was shocked to learn that Medicare would not approve any additional time for home health.
Now, my mother must pay for home care herself, which is provided by the assisted living facility, costing an extra $1,000 a month in her rent. Please explain how to find the right home health company when there is a medical need. — Steffanie, Boston
Dear Steffanie: The medical care that Medicare pays for is skilled nursing in a facility, which Doris used after she left the hospital. With skilled nursing, the first 20 days are at no cost, with days 21 to 100 costing $217 per day as of Jan. 1. After the 100th day, the beneficiary pays 100 percent out of pocket.
The 2026 “Medicare &You” handbook explains: “Medicare covers home health services under Part A and/or Part B. Medicare covers medically necessary part-time or intermittent skilled nursing care.” The handbook does not say full time, and that is where your problem begins, Steffanie. Your mother needs additional care because she has a serious health issue and is homebound.
Because of your mother’s health issues, she will still be receiving the home health services as long as medically necessary.
Finding the right home health agency can be difficult. Here is what the National Association of Home Care suggests asking to help narrow the search:
■ Is the agency Medicare certified?
■ Is the agency licensed by the state?
■ What are the credentials of the agency’s caregivers?
■ Are the healthcare professionals, nurses and caregivers employees or contract workers for the home health company bonded and insured?
■ Will there be a written plan of care for each patient?
Do not forget that there must be a medical need for Medicare to pay for services provided by a home health company. Medicare does not pay for custodial care.
Securing home health is not complicated:
■ A doctor must order home health and sign the plan document, which is sent to Medicare.
■ The home health agency schedules a face-to-face meeting with the patient and family members to determine what care and services are needed.
■ The plan of care and certification will last up to 60 days.
■ The 60-day periods will continue if she is improving, and her doctor must sign again to authorize the recertification periods.
■ Home health includes nursing care, physical therapy and other medical needs for Medicare recipients who are homebound.
Toni King is an author and columnist on Medicare and health insurance issues. If you have a Medicare question, email info@tonisays.com or call 832-519-8664.
