On Medicare: What to know about choosing a home health care agency

Dear Toni: My mother-in-law is 85 and lives on her own in an independent living facility. 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 are not Medicare certified and she must pay for at-home care herself. This is now costing us a fortune.

A friend told me about home health care and that Medicare will pay for it. I have investigated home health care agencies on the Medicare website and found more than 700 that are Medicare-certified in my area. How can we make the right Medicare decision choosing a home health care provider? — Jennifer, Little Rock, Arkansas.

Dear Jennifer: The 24-hour care that your mother-in-law was offered, and that Medicare would pay for, is skilled nursing. With skilled nursing, the first 20 days are at no cost with days 21-100 costing $200 per day.

During your Toni Says 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 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, and the 24-hour care at home is costing a fortune.

You are correct, trying to find the right home health care agency can be a daunting task because there are numerous Medicare-certified home health care agencies in your area to pick from. The National Association for Home Care &Hospice suggests asking several questions to help narrow your search, among them:

■ Is the agency Medicare certified?

■ Is the agency licensed by the state?

■ What are the credentials of the agency’s caregivers?

■ Are the health care professionals, nurses and caregivers employees agency or are they contract workers?

■ Do they provide 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 health care company. Home health care includes nursing care, physical therapy and other medical needs for Medicare recipients who are homebound. 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 receive home health care:

■ A doctor must order home health care and sign the plan.

■ The home health care agency then must schedule a face-to-face meeting with the patient and family members to cover what care and services are needed.

■ The plan of care and certification will last up to 60 days.

■ The 60-day plan of care should be recertified if the patient is improving, and the doctor must sign to approve the recertification periods.

Toni King is an author and columnist on Medicare and health insurance issues. For a Medicare checkup, email info@tonisays.com or call 832-519-8664.