What’s the difference between home health care and in-home care?

on Dec 26, 2024

Note: Due to the continued confusion on the issue, Toni is rerunning this column from May. It has been slightly updated.

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 3 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 discussing 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 in-home health care vs at-home care? Will Medicare pay for at-home care?

--Samantha from Tulsa, Okla.

Hi Samantha:

Do not feel like you are alone with this problem of aging parents, because 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 kind of situation is especially difficult when they can no longer care for themselves properly as you, Samantha, are experiencing with your parents.

I had the same stressful issue with my own mother and discussed different options with a home health agency representative, who explained how to maximize my mother’s Medicare dollars with home health care benefits, not at-home care.

Home Health Care

To receive home health care services from Original Medicare (not a Medicare Advantage Plan):

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

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

3. The beneficiary must need intermittent skilled nursing care, physical, speech, or occupational therapy.

4. The home health agency must be Medicare-certified. (If not Medicare-certified, then the beneficiary pays 100% of the home health charges.)

5. The beneficiary must be homebound. (“Homebound” means not leaving home without help from someone or aid from wheelchair, walker, cane, etc. due to illness or injury.)

Once these conditions are met, Original Medicare will cover the types of care listed below:

-- 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 co-pay or deductible for home health care and Medicare will pay 100% for any medical services provided by a home health care agency that accepts Medicare assignment.

Those with “Original” Medicare, not Medicare Advantage plans, have “Patient’s Rights” with 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. Please be sure you know which kind of benefits your elderly family members are receiving!

Under Original Medicare or a Medicare Advantage plan, the time spend at home with the patient for home health care is limited to “part-time or intermittent.” Neither will pay for help with daily at-home care of the patient once the medical need is taken care of that day. Page 43 of 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 8 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 with your personal dollars, not Medicare dollars. “At-home care” is non-medical, in-home care for the patient in support of aging while at home. Samantha, it would help you and your parents to build a long-term care needs plan with care at home from a few hours a day to 24-hour care.

Readers, you can email your long-term care questions for yourself or your loved ones to info@tonisays.com.

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Toni King is an author and columnist on Medicare and health insurance issues. She has spent nearly 30 years as a top sales leader in the field. For a Medicare checkup, call the Toni Says call center at (832) 519-8664 or email info@tonisays.com regarding your Medicare plans and options. Toni Says Medicare Survival Guide Advanced edition is available at www.tonisays.com.