UNITED STATES—Dear Toni:  Help!!! My mother-in-law is 85 and lives in an independent living facility on her own. After a hospitalization in November, she needed 24-hour medical care when she went home.

The hospital and the manager of the facility where she lives told us that Medicare would not pay for 24-hour home health care because she wanted to be at home and not go to a skilled nursing facility which she was offered.

The services the independent living facility offers is not Medicare certified and she must pay for at home care herself. This is now costing us a fortune.

She is improving and a friend told me about home healthcare and that Medicare will pay for it. I have investigated home healthcare agencies on the Medicare website and found over 700 agencies that are Medicare certified in my area. How can we make the right Medicare decision choosing a home healthcare provider for my mother-in-law? Thanks, Jennifer, Little Rock, AR.

Jennifer: The 24-hour away from the hospital medical care that Medicare would pay for is Skilled Nursing that your mother-in-law was offered. With Skilled Nursing, the first 20 days is at no cost with days 21-100 costing $200 per day beginning January 1, 2023.

During your Toni Says Medicare® consultation in November, you told me that your mother-in-law had a Plan F Medicare Supplement which would have paid for skilled nursing. Leaving her with $0 (Zero) out of pocket for her skilled nursing stay if it was medically necessary.

You also told me that she wanted to go home, refusing to go to the Skilled Nursing facility. Your husband (her son) made sure she got her wish and as you stated the 24-hour care at home is costing you an absolute fortune.

You are correct, trying to find the right home healthcare agency can be a daunting task because there are numerous Medicare certified home healthcare agencies in your area to pick from. The National Association of Home Care suggests asking the following questions to help narrow your search:

  1. Is the agency Medicare certified?
  2. Is the agency licensed by the state?
  3. What are the credentials of the agency’s caregivers?
  4. Are the healthcare professionals, nurses and caregivers employees or contract workers for the home health company?
  5. Will there be a written plan of care for each patient?

Do not forget that there must be a medical need for Medicare to pay for the services provided by a home healthcare company. Medicare does not pay for custodial care such as making sure your mother-in-law has a daily bath, gets dressed or is ready to go to bed. You will   pay for custodial care on an hourly basis.

To order home health is not complicated:

  • A doctor must order home healthcare and sign the plan.
  • The home healthcare agency schedules a face-to-face meeting with the patient and family members to develop what care and services are needed.
  • The plan of care and certification will last up to 60 days
  • And the 60-day recertification periods last if she is improving, and her doctor must sign to the recertification periods.
  • Home healthcare includes nursing care, physical therapy and other medical needs for Medicare recipients which are “homebound.”

Most Americans are not aware of the medical services they can receive from Medicare such as home healthcare that can help to enhance their recovery at home.

For a Medicare checkup, email info@tonisays.com or call 832-519-8664 to have your Medicare question answered. Medicare Survival Guide Advanced edition is available at www.tonisays.com.

Visit www.seniorresource.com/medicare-moments to listen to Toni’s Medicare Moments podcast and get other information for boomer/seniors.