How Much Does Medicare Pay For Home Health Care Per Hour?

Before a discussion of home care payment options, it is useful to differentiate between home care and home health care. Home Care Aides give custodial care. They provide assistance to people with their activities of daily living such as bathing, dressing, housekeeping and transportation. This is also known as personal care, attendant care, non-medical care and companion care.

Home Health Aides are able to provide care such as checking patients’ pulses, temperature, or respiration. They assist with medications, braces, ventilators and other medical equipment. And they will be able to provide higher-level skilled nursing as well as more basic personal care. Home health aides are also known as nurse aides, nursing assistants, certified nursing assistants and geriatric aides.

Costs: Home, Home Health & Alzheimer’s Care

Both home care aides and home health aides bill on an hourly basis (with the possible exception of live in caregivers who sometime bill flat rates).  Home care aides can be hired through a home care agency or by hiring private caregivers. Home health aides have greater federal regulation and are almost always hired through an agency.

Hourly rates for home care might vary by as much as 50% even in the same state or town.

Nationwide in 2019, the average cost for non-medical home care is $21.00 per hour with the state averages ranging from $16.00 – $28.00 per hour.  It must be noted that these are average costs come from home care agencies.  Private individuals can be hired to provide most of the same services with fees that are 20% – 30% lower.  However, independent caregivers are usually uninsured, do not go through background checks and might not be able to provide alternatives in case they are not available to work on short notice.

Independent caregivers typically charge 20% – 30% less than home care agencies. 

Home health aides are visiting the home as much as medically necessary; typically for shorter periods of time than home care aides. In 2019, nationwide, the average hourly fee is $22.00. Different state averages range from $16.00 to $30.00 per hour.

Alzheimer’s care at home can be affordable and relatively low cost when it is compared to residential care. Typically, home care providers do not charge more fees to care for individuals with Alzheimer’s. This is not the case in senior living residences where Alzheimer’s and dementia care usually costs an additional $800 – $1,200 per month.

Financial Assistance for Home Care

Original Medicare will not pay for non-medical, home care aides and only selectively covers home health care. Medicare Advantage, on the other hand, can include non-medical, home care aides depending on one’s plan.

There are numerous misconceptions around Medicare’s benefits for home care. Original Medicare, also referred to as traditional Medicare, does not pay for non-medical care at all. Consequently, assistance for non-medical care provided in the home is not covered. Medicare Supplemental Insurances include Medicare co-payments and deductibles. But they do not add new areas of coverage so  these policies are of no help for non-medical home care.

However, when home health care is deemed medically necessary, it is covered, at least in part, by Medicare and other health insurance programs. However, original Medicare severely limits coverage to only those individuals who are “homebound”. This is defined as persons who require assistance (by human or medical equipment, such as wheelchairs) to leave home. Alternatively, persons whose health may be made worse by leaving their homes are also eligible. During home health care visits, Medicare is not going to pay for any personal care that is provided during that visit. Visits tend to be short and procedural in nature. 

Medicaid

Medicaid, an insurance program for low income persons, pays for non-medical home care, home health care, and other in-home supports to provide assistance to individuals remain living in their homes. However, Medicaid rules are state-specific. Meaning, eligibility and benefits differ in every state. When Medicaid provides care outside of nursing homes, it is referred to as Home and Community Based Services (HCBS). HCBS can be covered under the following:

• Regular Medicaid, often called State Plan Medicaid
• Medicaid Waivers, also called 1915(c) Waivers or HCBS Waivers
• A relatively new state plan program called the Community First Choice Option (CFCO)

Regular / State Plan Medicaid is an entitlement program, so is CFCO. Anyone who meets the eligibility requirements can receive entitlement services. But, waivers are not entitlements. A limited number of slots are available and waiting lists are common for Medicaid waiver programs. The majority of states cover home care for the elderly (both non-medical and home health) in both their State Plan and their waivers. 

Veterans Programs

There are numerous forms of assistance from the Department of Veterans Affairs (VA) that help veterans afford home care.  This may be direct financial assistance or care services that can decrease a veteran’s overall need. 

To start, there are three different pension benefits (cash assistance) which can be applied towards home care.  Individuals who need more care are eligible for higher benefit amounts.  These are the Improved Pension, Housebound, and Aid and Attendance.  Veterans can also receive care assistance through Veterans-Directed HCBS, a relatively new program. This program allows for self-direction of services. Also available to veterans is the VA Respite Care program, which may reduce the home care hours a veteran requires.  

State Non-Medicaid Programs

Most states have in-home assistance programs meant for low income seniors who are not eligible for Medicaid. These programs are designed to prevent or delay the placement of needy individuals in nursing homes. They are loosely described as “nursing home diversion programs.” Eligibility, benefits and even sources of funding varies with each program. Some states even have more than one program.  As an example of the diversity, some of these programs offer cash assistance; others provide care services and respite. And still others provide non-care based, in-home support, like assistance with chores, meals, and transportation. Help with adult day care and assistance for home modifications to enable aging in place are two other ways the states use to help.  The common thread amongst all these programs is that they help seniors remain living at home or assist their families in caring for seniors in place.