Does Medicare pay for visiting angels

Guiding Medicare coverage for in-home care can be confusing, especially when it comes to private agencies like Visiting Angels. Many families turn to caregiving services to help their aging loved ones stay safely in their homes, but the costs can add up significantly. A common question people ask is: does Medicare pay for Visiting Angels? The answer is nuanced and depends on the type of care being provided, as well as whether it meets Medicare’s eligibility criteria. This blog aims to clarify what Medicare covers and does not cover in terms of in-home services, helping you make an informed decision.

Does Medicare Pay for Visiting Angels Services?

In most cases, Original Medicare does not pay for Visiting Angels services if the care provided is considered custodial. Visiting Angels offers a range of non-medical caregiving support, including assistance with bathing, dressing, meal preparation, transportation, and companionship. These are extremely valuable services, but they typically fall under custodial care, which Medicare does not cover.

However, there are limited situations where Medicare might help cover certain services if they are deemed medically necessary and meet specific criteria, particularly if they are part of a broader home health plan provided under Medicare-certified agencies.

What Is the Difference Between Skilled Nursing Care and Custodial Care Under Medicare?

To comprehend what Medicare covers, it’s crucial to distinguish between skilled nursing care and custodial care:

• Skilled nursing care encompasses medical services delivered by licensed professionals, including wound care, physical therapy, and medication administration. These are typically covered by Medicare when prescribed by a physician and provided through a certified home health agency.
• Custodial care, on the other hand, refers to assistance with daily activities like bathing, eating, and dressing. While vital for quality of life, these services are not considered medical care. They are not covered by Medicare unless provided as part of a broader home health plan.

How Does Medicare Define and Cover Custodial Care and Home Health Aide Services?

According to Medicare.gov, custodial care is care that assists with daily living tasks but does not require specialized medical training. Medicare only protects home health aide services if:

• You are homebound and require intermittent skilled nursing care, and
• The home health aide services are part of your care plan under a Medicare-certified agency.

Even in this scenario, the home health aide’s role is limited to confidential care, such as bathing and dressing, and is only covered when skilled nursing or therapy services are also being received.

When Does Medicare Cover Skilled Nursing Care Provided in the Home?

Medicare protects part-time or intermittent skilled nursing care in your home under the following conditions:

• Your doctor certifies that you are homebound.
• You require skilled services like injections, wound care, or physical therapy.
• The care is provided through a Medicare-certified home health agency.

If these standards are met, Medicare may cover the full cost of skilled care, provided it is needed. Once skilled services are no longer required, coverage for associated home health aide services will also end.

How Much Do Home Health Services Typically Cost When Using Medicare Coverage?

When eligible, Medicare Part A or Part B generally covers:

• 100% of approved home health care services, including skilled nursing, physical therapy, and occupational therapy.
• 80% of the cost for durable medical equipment (DME), like walkers or hospital beds.

Patients usually do not pay anything out of pocket for home health care services if all requirements are met and the agency is Medicare-certified. However, any non-covered services, including long-term custodial care, must be paid out of pocket.

What Is Visiting Angels and What Type of Services Do They Provide?

Visiting Angels is a private, nationwide home care agency that specializes in non-medical, in-home support for elders. Services may include:

• Personal hygiene assistance
• Meal preparation
• Medication reminders
• Transportation
• Light housekeeping
• Companionship

These services help older adults live independently at home. Still, because they are non-medical in nature, they typically do not qualify for Medicare reimbursement. This is an important consideration when budgeting for long-term care.

How Does Medicare Cover Home Health Services and What Are the Limitations?

Medicare does a good job covering short-term medical care at home. Still, its coverage is restricted to particular conditions:

• You must be under a doctor’s care.
• A doctor must create and review your care plan.
• The services must be medically necessary and intermittent in nature.
• You must receive the care from a Medicare-approved home health agency.

Medicare does not cover 24/7 home care, meals delivered to your home, or custodial services that are not part of a skilled care plan. 

Who Qualifies for Medicare-Covered Home Health Services Based on Medicare’s Criteria?

To qualify for Medicare-covered home health care, the following must apply:

1. You are under the care of a doctor and receiving services according to a care plan.
2. Your doctor certifies that you need one or more of the following:

• Intermittent skilled nursing care
• Physical therapy
• Speech-language pathology services
• Continued occupational therapy

1. You are homebound, meaning leaving your home takes considerable effort.
2. A Medicare-certified home health agency provides the care.

These requirements are strict, and failing to meet any of them will result in full responsibility for the cost of care.

 How Much Do Visiting Angels Services Cost Without Insurance?

The expense of Visiting Angels services without insurance varies by region, type of care, and frequency of care. On average:

• Hourly rates range from $25 to $35.
• Live-in or overnight care can cost between $200 and $300 per day.

Since Medicare typically doesn’t pay for Visiting Angels, families often use long-term care insurance, private savings, or Medicaid (if eligible) to help offset costs. 

What Does It Mean to Be Homebound According to Medicare’s Definition?

To qualify for Medicare home health services, you must be homebound, which Medicare defines as:

• Leaving your home is medically inadvisable, or
• It requires considerable effort and assistance due to a medical condition.

Occasional absences, like going to religious services or a doctor’s appointment, are allowed. However, routine trips outside the home disqualify you from being considered homebound under Medicare rules.

Can Visiting Angels Services Qualify for Medicare Reimbursement Under Home Health Coverage?

In rare cases, Visiting Angels services may qualify for Medicare reimbursement—but only if:

• The local Visiting Angels agency is Medicare-certified (most are not), and
• The care provided is part of a Medicare-approved plan of care involving skilled nursing.

Because the majority of Visiting Angels locations focus on custodial care, their services fall outside of what Medicare traditionally reimburses. It’s essential to ask your local office whether any of their staff or services fall under a Medicare-certified program.

Conclusion: Is Medicare Enough for In-Home Care?

For families asking, does Medicare pay for Visiting Angels? The short answer is usually no, unless the services fall within Medicare’s strict definitions of skilled care. Visiting Angels primarily offers non-medical support that’s vital but not covered by Original Medicare. To plan for aging in place, consider incorporating Medicare with other options like long-term care insurance, Medicaid (if eligible), or out-of-pocket funding.

Understanding Medicare’s rules can help you find the right balance of affordability and quality care. While Medicare plays a crucial role in covering short-term, medically necessary services, it is not a comprehensive solution for long-term, daily in-home care.

Disclaimer: This article is for informational purposes only. Medicare coverage and costs can vary by region, plan type, and individual circumstances. Always speak directly with your provider or Medicare representative for the most accurate information.

Source: healthcare.gov