How to maximize Medicare dollars with home health care benefits

Dear Toni: I need your help regarding my parents, who are in their late 80s. My mother has been disabled with Parkinson’s for the past three years, and my father has been her caretaker. But due to his recent heart attack, he can no longer assist her.

They do not have a long-term care plan, and 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? — Samantha, Tulsa, Okla.

Dear Samantha: Many baby boomers are experiencing just what you’re facing. Elderly parents do not want to lose their independence by not controlling their finances. This type of situation is especially difficult when they can no longer care for themselves properly.

I had the same stressful issue with my own mother. Thankfully, a home health agency explained how to maximize her Medicare dollars with home health care benefits, not at-home care.

Home health care

To receive home health care services from original Medicare:

■ There must be a medical need to receive Medicare-certified home health care services.

■ Primary care or specialists must order the home health care services.

■ You must need intermittent skilled nursing care, physical, speech or occupational therapy.

■ The home health agency must be Medicare-certified. (If not Medicare-certified, then you pay 100 percent of the home health charges.)

■ You must be homebound (not able to leave home without help from someone or aid from a wheelchair, walker, cane, etc., because of illness or injury).

Once these conditions are met, original Medicare will cover:

■ 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 an illness or injury.

■ Physical, speech or occupational therapy.

With original Medicare, there is not a copay or deductible for home health care, and Medicare will pay 100 percent for any medical services provided by a home health care agency that accepts Medicare assignment.

People with original Medicare have the right to choose which home health care agency to use. Those enrolled in a Medicare Advantage plan must use network providers, and there may be a limit on how much home health care one can receive.

Under original Medicare or a Medicare Advantage plan, home health care is limited to “part time or intermittent.” 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 eight 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 and is paid for out of pocket. At-home care is nonmedical, in-home care for the elderly in support of aging while at home.

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.