Q: Where do I start to find coverage for home health care services?
Start by searching the federal government's Eldercare Locator to find your local Area Agency on Aging. These agencies have resources on home health care and are the gateway to Medicaid, if needed.
You can also check the National Council on Aging's BenefitsCheckUp to learn which programs you or your loved one may qualify.
Help with home-care bills may be available through Medicaid if the care recipient has a low income or limited assets. Speak with your Medicare representative to find out which home health services and under which circumstances, are covered.
If applicable, contact the Department of Veterans Affairs (VA) to see if your loved one qualifies for home-care support as a former service member.
Contact your local PACE organization.
Lastly (or maybe firstly), speak with your tax accountant regarding tax deductions available. Then, when you are fully informed, speak with your loved one's doctor to form a plan of action.
Q: What is the difference between home care and home health care?
Home Care providers supply companionship and assistance for those who wish to remain at home but are not incapacitated or in need of medical care. The purpose of Home Care is to increase the quality and security of day-to-day life allowing your loved ones to age in place.
Home Health Care providers do all the above and more. The provider works with the family to understand what the client needs and keeps the family apprised of the general health and wellness of the patient. A Home Health Care provider covers the day-to-day care with non-medical staff in addition to registered nurses who handle regular healthcare check-ups, administer medicine, evaluate the living conditions and health/wellness of the patient, potentially respond in an emergency, and coordinate with facilities if needed as the patient requires increasing levels of care.
Q: How can I afford home health care services?
Those who wish to age in place can plan for the future by purchasing long-term care insurance or a life insurance policy with a rider for long-term care, sometimes called hybrid policy. But its not cheap: the most recent available information from the American Association for Long-Term Care Insurance, the cost averages almost $3,800 a year for a couple. We have personally found it to be quite a bit higher and it very much depends on the age of the couple and services needed.
Q: What are the costs of home health care without insurance coverage?
Those without long-term care insurance often rely on an unpaid family caregiver for a time, but eventually many need to turn to paid help, particularly when the need for health-related services arise. The costs of these services range quite a bit: According to insurance company Genworth's 2019 survey on the cost of long-term care, the national average bill for a home health aide is $4,385 a month.
NOTE: You can get help paying for in-home care if you don't have insurance coverage for long-term care and can't afford to pay out of existing financial resources. These include, but are not limited to, Medicare, Medicaid, Veteran's Programs, tax deductions, and PACE.
Q: What are people using to pay for home health care out of pocket?
Many create a budget to pay for home healthcare from multiple sources, among them:
Investments and savings
Life insurance policies that can be used for qualified home-care expenses through cash value or an accelerated death benefit
Borrowing, for example by taking out a reverse mortgage or home equity loan
Q: What government or other financial assistance is available for home health care?
You can get help paying for in-home care if you don't have insurance coverage for long-term care and can't afford to pay out of existing financial resources. These include, but are not limited to, Medicare, Medicaid, Veteran's Programs, tax deductions, and PACE.
According to AARP, Original Medicare can cover the full cost of medically necessary home health care on a limited basis for beneficiaries who are unable to leave home without assistance. That could include:
- Skilled nursing care
- Occupational, physical and speech therapy
- Home health aide services, if the recipient also needs therapy or skilled nursing
Original Medicare can cover routine home care daily activities such as help with bathing and dressing as well as basic medical care such as checking vital signs and dressing wounds—only on a part-time or intermittent basis, but only if a doctor orders it as part of a broader plan of care. Original Medicare will not pay for full-time home care or for personal and home services if that is the only help needed.
However, Medicare Advantage plans (which are private insurance policies that match Original Medicare's coverage but can provide additional benefit) have the option to offer broader and longer-term coverage for home health services. For example, an MA plan might cover a personal care aide even if the recipient does not need therapy or skilled nursing. Check with the plan provider to understand what is available for each particular plan.
The Medicaid joint federal-state program does pay for home health care, some residential and assisted living care, and nursing home care. According to AARP, more than half of all Medicaid spending on long-term care goes toward home- and community-based services.
Note: Home health services available for coverage are more limited under Medicare than Medicaid, but since each state runs its Medicaid program differently, eligibility and benefits vary.
III. Veteran's Programs
Eligible former service members may qualify for one of several VA programs that help pay for care at home, including Aid and Attendance benefits, Housebound benefits, Veteran Directed Care, and Homemaker and Home Health Aide Care. Contact your regional VA benefits office for information.
IV. Tax Exemption
Caregivers hiring and paying for home care for medical reasons may qualify for a federal tax deduction. (Same with those paying for a nursing home.) Additionally, an adult child serving as a caregiver for a live-in parent also can get a tax break by claiming the parent as a dependent but the child must meet certain criteria, including providing more than half of the care recipient's financial support.
Programs of All-Inclusive Care for the Elderly (PACE) is a small but growing Medicare and Medicaid initiative aimed at keeping frail seniors out of nursing homes. Currently, 131 PACE programs operate 263 PACE centers in 31 states, serving more than 51,000 participants. Find one near you by clicking here.
Among other things, PACE covers in-home care, adult day care, checkups, hospital and nursing home stays, prescriptions and some transportation for medical purposes. It can also pay for training, support and respite for family caregivers. Local PACE organizations work with medical providers who form the recipient's health care team. If the team decides a loved one needs care that Medicaid or Medicare doesn't provide, PACE still may cover it.
To be eligible, someone must be:
- 55 or older
- In need of nursing home-level care as certified through your state
- A resident of an area with a PACE organization
- Able to live safely in the community with help from PACE. People with Medicare, Medicaid or both can qualify although if you have Medicare only you might be charged a monthly premium. Those not covered through either program can pay for PACE privately.