Glossary
Home health care coverage, defined
The portion of a policy or Medicare benefit that pays for skilled nursing, therapy or personal assistance delivered where the person lives rather than in a facility. It lets someone who qualifies for help stay in their own house, with the policy paying the aide, nurse or therapist.
In practice
In a long-term care policy the daily maximum for in-home services is sometimes lower than the facility maximum, and older policies may exclude it or require a licensed agency, which rules out paying a family member or an independent aide. Medicare covers it only for intermittent skilled care ordered by a doctor for a homebound patient; it does not pay for ongoing custodial help with bathing and meals, which is where a private policy earns its keep. Check whether the elimination period is counted in service days, whether homemaker services and adult day care are included, and whether the benefit pays informal caregivers under a cash alternative. Newer policies often pay the full daily maximum at home.
A worked example
Suppose a policy pays a $200 daily maximum in a facility and 75% of that at home. A retiree who needs an aide four hours a day at $35 an hour incurs $140 a day; the policy pays up to $150 at home, so it covers the bill. Under a policy with a 50% home benefit the cap would be $100 and the family would pay $40 a day. Hypothetical figures.
Applies to: Medicare