At least once a day, often many time a day, we receive a call from a client's family member that says "I just talked to my loved one's insurance company, and they said they will pay for up to 35 hours a week of home care". These conversations usually end with the caller upset and very confused. This is because the way the insurance presents the information is very confusing causing the caller a lot of run around. Fortunately with 28 years of experience, we can offer you a clear explanation and break down of what this "35 hours" really means.

"Home Care" is an umbrella term that describes all forms of home care available. Insurance companies use this term broadly to describe services and it can be very misleading when trying to determine what your insurance will pay for at home. Many people have spoken to their insurance and are told that " we will cover up to 35 hours a week of Home Care". Here is what that really means:

Medicare, like all other medical insurances (Anthem, Blue Cross, Etna, Etc.) only pay for medical home care. Examples of this would be home care ordered by a physician for an acute/short term medical treatment need. This would include registered nurses for care such as wound changes, IV treatments, as well as Physical, Occupational and Speech therapy. This medial care is always short term, usually right after a hospital stay. While receiving the care of RNs and therapists at home, a bath aide may also be sent out a few times a week. Each of these specialties will come out for about an hour at a time for each of their visits. While receiving this kind of care, most people will never reach "up to 35 hours a week". That happens when a client needs daily wound care by an RN or IV changes multiple times a day by an RN in addition to the therapy they are getting and possibly a bath aide. That is were "up to 35 hours" comes in, when the total of all in home medical care reaches 35 hours a week. It usually does not.

Activity of Daily Living (ADL) assistance like bathing, dressing, incontinence care, transfer/mobility assistance, supervision, housekeeping, meal preparation and other daily tasks are part of Home Care services but are not considered to be medical care and so cannot be billed to any medical insurance. This kind of care is NOT included in the "up to 35 hours a week" that insurances state they provide. Although a medical concern may have been what prompted a client to need this kind of help at home, it is not considered medical care. Our caregiver services are considered non-medical and thereby not billable to any medical insurance. 

As you navigate the murky insurance waters, we are happy to help you in any way we can. Please see the "Paying for Home Care" tab on our website for helpful links to other possible funding resources for your non-medical home care needs.