Is Visiting Angels home care covered by Medicare? Understanding Your Options

According to the Centers for Medicare & Medicaid Services, Original Medicare generally covers medically necessary skilled care, not long-term custodial care. This crucial distinction directly impacts whether Is Visiting Angels home care covered by Medicare?, a question with a nuanced answer that requires understanding the specifics of your plan.

Quick Summary

Medicare rarely covers the non-medical, personal care services primarily provided by Visiting Angels, such as assistance with daily living activities. Coverage is limited to medically necessary, short-term skilled care, requiring strict criteria to be met. Families should explore alternative payment methods or insurance plans for long-term support.

Key Points

• Custodial vs. Skilled Care: Medicare covers short-term, medically necessary skilled care, not the long-term custodial care that makes up most of Visiting Angels' services.

• Homebound Status: Eligibility for any home health coverage under Original Medicare requires a doctor to certify that the patient is homebound.

• Medicare Advantage Exception: Some Medicare Advantage plans (Part C) may offer coverage for specific non-medical home care services, so checking your plan is essential.

• Medicaid Alternative: For those with limited financial resources, Medicaid is a primary source of funding for long-term custodial care services in the home.

• Private Pay Agency: Visiting Angels operates on a private-pay basis, though some services may be covered by long-term care insurance policies.

• Incidental Aide Services: A home health aide's services may be covered by Medicare, but only when a patient is also receiving skilled care for a temporary period.

The Core Distinction: Skilled vs. Custodial Care

When evaluating if Visiting Angels' services are covered by Medicare, the most important factor is understanding the difference between skilled and custodial care. This distinction is the foundation of Medicare's home health coverage policies and is the reason many home care services are not reimbursed.

• Skilled Care: This is medically necessary care provided by a licensed medical professional, such as a registered nurse or a physical, occupational, or speech therapist. Examples include giving injections, changing wound dressings, or observing a patient's health status after a serious illness or surgery. Medicare will cover skilled care when it is ordered by a doctor for a specific, treatable medical condition and when the patient is certified as homebound.
• Custodial Care: This refers to non-medical assistance with activities of daily living (ADLs). This includes tasks like bathing, dressing, grooming, using the toilet, and eating. The majority of services provided by agencies like Visiting Angels fall under this category. Medicare does not cover custodial care when it is the only type of care needed.

The Fine Print on Skilled Care Coverage

Even when skilled care is involved, Medicare's rules are specific. For Medicare Part A or Part B to cover home health services, a beneficiary must be officially certified as 'homebound' by a doctor. Being homebound means that leaving home requires a considerable effort and isn't a routine event. Furthermore, the care must be intermittent, or part-time. It cannot be 24-hour, round-the-clock care. This means that if an individual requires only help with bathing and dressing, with no accompanying need for skilled medical services, Medicare will not provide coverage.

Medicare and Visiting Angels: How They Interact

Visiting Angels operates primarily as a private-pay agency, meaning clients and their families typically pay for services directly. While it's a Medicare-certified provider, this certification only means the agency can provide services that are covered by Medicare, not that Medicare will cover all services it offers.

Here’s a breakdown of the typical situation:

• If a senior needs part-time skilled nursing or therapy following a hospital stay, and also needs a home health aide for personal care during that same period, Medicare might cover the aide's services in conjunction with the skilled care. The aide's services would be considered incidental to the primary skilled care needs.
• Once the need for skilled care ends, so does Medicare's coverage for the home health aide. The ongoing custodial care provided by Visiting Angels would then become a private expense.
• A local Visiting Angels office can offer services like companion care, meal preparation, and light housekeeping, none of which are ever covered by Original Medicare.

Other Potential Payment Options and Resources

For those who find that Medicare will not cover their desired Visiting Angels services, several other avenues exist to help manage the cost of care. Exploring these options is critical for long-term planning.

Comparison of Coverage Options

Feature	Original Medicare (Parts A & B)	Medicare Advantage (Part C)	Medicaid	Long-Term Care Insurance
Covers Custodial Care?	No, generally not.	May offer some coverage, benefits vary by plan.	Yes, for eligible individuals.	Yes, depending on the policy.
Focus	Short-term, medically necessary skilled care for the homebound.	Combines A and B, often includes extra benefits.	Needs-based, state-specific coverage.	Private insurance for long-term care needs.
Requires Homebound Status?	Yes	Often, but rules vary by plan.	No	No
Eligibility	Age 65+ or certain disabilities.	Must be enrolled in Medicare Parts A & B.	Income and asset-based criteria set by the state.	Paid premiums, health screening.
Provider Network	Any Medicare-certified provider.	May be limited to a specific network.	Must use approved providers.	Any provider that accepts the policy.

How to Navigate Your Options

1. Check with a Local Visiting Angels Franchise: The first step should be to contact your local Visiting Angels office. They are knowledgeable about their services and can provide a free consultation to discuss your specific needs. They can also explain payment options, including long-term care insurance and private pay arrangements.
2. Contact Medicare Directly: Call 1-800-MEDICARE or visit the official Medicare website to understand the precise rules for your situation. The specifics can be complex, and getting information directly from the source is always recommended.
3. Explore Medicare Advantage Plans: If you are enrolled in a Medicare Advantage Plan (Part C) through a private insurer, contact your provider. Many Advantage plans offer additional benefits not covered by Original Medicare, such as coverage for non-medical in-home support.
4. Investigate Medicaid Eligibility: Medicaid is a joint federal and state program that helps with medical costs for people with limited income and resources. Most states offer some level of home and community-based services through Medicaid waivers, which could cover a wider array of custodial care than Medicare. The eligibility criteria are based on financial need, which can be different depending on your state. You can learn more about eligibility on the official Medicaid.gov website.
5. Review Long-Term Care Insurance: If you or a loved one has a long-term care insurance policy, it may cover some or all of the costs for services provided by Visiting Angels. Review your policy details or contact your insurer to understand your benefits.

Conclusion

While the simple answer to “Is Visiting Angels home care covered by Medicare?” is often no, the more complex and helpful answer is that it depends on the type of care needed and your specific insurance plan. Original Medicare only covers medically necessary, short-term skilled care for beneficiaries who meet the 'homebound' criteria. The custodial and companion care services that are a major part of the Visiting Angels offering are generally not covered. It is essential for families to proactively explore all payment alternatives, including Medicare Advantage, Medicaid, and long-term care insurance, to ensure their loved one receives the comprehensive support they need.

Frequently Asked Questions

Does Medicare pay for a Visiting Angels caregiver to help with bathing and dressing?

No, Medicare typically does not cover assistance with daily living activities like bathing and dressing, as this is considered custodial care. Coverage is only provided for skilled, medically necessary services.

Can I get Medicare to cover Visiting Angels if I am recovering from surgery?

If a doctor certifies that you require part-time skilled care (like physical therapy or wound care) after surgery and you are homebound, Medicare may cover a home health aide's personal care services for a temporary period alongside the skilled care. Once the skilled care is no longer needed, the coverage for the aide ends.

What is the difference between Visiting Angels and a Medicare-certified home health agency?

Visiting Angels is a home care agency that provides both medical and non-medical services. As a Medicare-certified provider, it can offer skilled care that Medicare may cover, but it also offers a broader range of non-covered custodial care services. A traditional Medicare-certified home health agency focuses primarily on skilled medical care.

Will my Medicare Advantage plan cover Visiting Angels home care?

Possibly. Coverage for non-medical home care varies significantly between Medicare Advantage plans. You must contact your specific plan provider to confirm if and to what extent they cover these services.

How can I pay for Visiting Angels if Medicare doesn't cover it?

Alternative payment options include using long-term care insurance, exploring state-level Medicaid programs (if eligible), using Veterans Affairs (VA) benefits, or paying for services directly out-of-pocket.

Does Visiting Angels offer any services that Medicare will cover?

Yes, if a doctor prescribes specific, intermittent skilled services and the patient is homebound, Medicare may cover those particular services, such as skilled nursing or certain therapies, if provided by a Medicare-certified office of Visiting Angels.

Is homebound status a requirement for Medicare coverage of Visiting Angels?

Yes, for Original Medicare (Parts A & B) to cover any in-home skilled services, a doctor must certify the patient is homebound, meaning they have significant difficulty leaving home without assistance.

Does Medicare cover hospice care from Visiting Angels?

Yes, if a patient is terminally ill and qualifies for hospice benefits, Medicare can cover hospice care provided by a Medicare-certified hospice agency. A Visiting Angels office can be part of this broader care plan if it works with a qualifying hospice provider.