Prescribed only by a physician, home health care is skilled nursing care that aids in the recovery from illness, injury, or surgery in the patient’s home. And fortunately for many seniors who are now opting for care at home, Medicare insurance covers most costs related to home health care.The government, however, has set some limitations on payouts – you are only eligible if you need intermittent care (usually defined as seven days a week or less than eight hours a day over 21 days or less) (1), physical/occupational therapy or speech language pathology; you are homebound; and the home health care agency providing care is approved by your Medicare insurance program.In addition to medication administration, general supervision, and therapy services, the Medicare home health benefit covers a number of other necessities, including medical aids and supplies to aid in recuperation. On the occasion, though, you may be required to cover some of the costs associated with home health care. But what can you expect to pay out-of-pocket that’s not covered by Medicare dollars?Medicare Insurance: Part A and Part BHospital Insurance (Medicare Part A) helps cover the costs of your inpatient care at hospitals, skilled nursing facilities, or religious non-medical health care establishments. Part A can also help cover hospice and home health care services. Individuals aged 65 and older are usually automatically enrolled in Medicare Part A and do not have to pay a monthly premium if Medicare taxes were paid while working. If you did not pay taxes, you are still eligible, but you will be required to pay a monthly premium.Medical Insurance (Medicare Part B) helps cover services such as those offered by your physician and outpatient care. Many seniors maintain their enrollment in Part A, but elect not to use Part B, which requires a monthly premium that is dependent upon income, the requirements of which change yearly. Unfortunately, if you didn’t sign up for Part B when you were first eligible for insurance, your premium may be slightly higher (2).For questions on your Medicare insurance benefits, you should contact 1-800-MEDICARE or read the handbook mailed to you each year entitled “Medicare and You.”What’s Covered and What’s NotMedicare insurance pays for physical and occupational therapy and speech language pathology services, counseling, some medical supplies, durable medical equipment (which must meet coverage criteria), as well as general assistance with daily activities which include dressing, bathing, eating, and toileting. For most other medical equipment, Medicare insurance will cover 80% of its cost (3).However, Medicare will not cover twenty-four hour care at home, meals delivered to your home, and services unrelated to your care such as housekeeping. Of course, as mentioned above, you will be required to pay 20% for medical equipment not fully covered by Medicare insurance such as wheelchairs, walkers, and oxygen tanks (4).In some cases, your home health care agency may present you with a Home Health Advance Beneficiary Notice (HHABN), which, simply put, means if your agency is ceasing your care services, you will be presented with a written statement outlining the supplies and services the agency believes your Medicare insurance benefits will not cover as well as a detailed explanation of why. Should this situation arise, you do have recourse – the HHABN lists directions on acquiring the final decision on payment issues or filing an appeal if Medicare refuses to cover costs for home health care. In the meantime, you should continue receiving home health care services, but keep in mind that you will be paying for these services out-of-pocket until Medicare accepts your claims and remits past expenses.Medigap and Other Out-of-Pocket ExpensesMedigap, a supplemental insurance policy, is sold privately and covers the services and supplies not paid for by Medicare insurance. When used in conjunction, Medigap and Medicare can often cover a large majority of the costs of your home health care. Insurance companies offer a variety of different Medigap policies (A through L), but since each one comes with specific benefits, you’ll need to compare the highlights closely. Medigap policies vary by cost, and many insurance companies require you to have both Medicare Parts A and B in order to purchase a supplemental plan (5).For seniors with both Part A and Part B Medicare, your home health care situation is usually covered, save for the 20% out-of-pocket expenses for medical equipment. Just remember to keep track of your Medicare insurance benefits (and Medigap if applicable) by verifying with your physician, home health care agency, and insurance representative. Paying for home health care does not have to cost you an arm and a leg, but do be prepared for the occasional (but necessary) out-of-pocket medical expenses.Sources1. Centers for Medicare and Medicaid Services, Medicare and Home Health Care, page 6
2. Medicare website: “Your Medicare Benefits.”
3. Ibid.
4. Ibid.
5. Medicare website: “Medigap (Supplemental Insurance) Policies.”

I’ll be blunt and get right to the three points of this article.
Point 1. Health care and health insurance should be separated.
Point 2. If it weren’t for the fact that health insurance has come to mean health care for most Americans there would be no health care reform.
Point 3. The only way to fix America’s health care once and for all is to bifurcate health care and health insurance as they should be.I’ll also give you three reasons why I say this so if you choose you can go to other articles and not bother with reading this further.
Reason 1. Because health care is now paid for by a third party health insurance premiums have increased over 100% since 2004.
Reason 2. On average over 60% of every health care dollar is wasted in the health insurance claims process.
Reason 3. Because of the health insurance/health care connection Americans are being robbed of their most precious birthright – their health.By means of government and health insurance company propaganda health care has been synonymous with health insurance since most of us can remember. At some point who among us hasn’t thought we needed a job with “benefits,” or maybe better benefits, so we could go to the doctor. We have been brainwashed by a system that profits monstrously from our lack of knowledge or apathy – whichever the individual case may be. We have been taught from our first paycheck that health insurance is the be-all-end-all when it’s time to take the kids to the doctor for a runny nose.That is confirmed within days when we get bill from the doctor’s office that says that the cost for that visit was $225.00.The system is rigged and it’s rigged so that each and every American thinks that someone else should pay for their health care. More on that later.Health care should be separated from health insurance like car care is separated from car insurance. When it’s time for an oils change do you reach in your pocket for your car insurance card to pay for it? “Of course not.” you say, “That would be ridiculous.”I ask you now to stop for a second and think why that would be a bad idea.In case you don’t know, let me give you a little primer on insurance. Insurance premiums are based on, among other things, claims – both the number and the amount of the claims. The individual states Department of Insurance ride herd over insurance companies to see that the amount paid out in claims is in proportion to the amount collected in premiums. So an insurance company doesn’t get a rate increase unless they have the claims to substantiate the increase. (That, by the way, is the one good service that the departments of insurance serve, since as individuals we don’t have the time nor the inclination nor the resources to look all of that information up.)So let’s now go back to the oil change scenario and look at it again. Instead of the one, two or three claims that you may file in a lifetime on your car insurance, you now find yourself filing a claim every three months or 10,000 miles. What would you expect your premiums to be like? How much would they increase? Also take this into consideration; your local mechanic or oil change service would have to wait 90 to 120 days to get paid for their money for the oil change. Plus there would be layer upon layer of paperwork to file the claim. The fact is, that if car insurance was like health insurance, your local oil jockey would have to hire an entire billing department just to file the correct forms with the correct codes – not once – but maybe as many three or four times.Do you think the oil change would still be $35.00 at your local Spiffy Lube would still be $35.00 or with the added payers of paperwork and personnel would the cost go up?The average face time with a medical doctor in the United States in now less than 10 minutes. The average amount of office labor involved in collecting the money for that 10 minute visit is upwards of three hours. How much is that costing you? Since there are no statistics kept on this let me do the simple math for you here. Billing and coding personnel make an average of $15.00 an hour. That could mean as much as $45.00 of your health care dollar goes toward processing your claim… and that is just at the doctor’s office. To be fair it is probably close to $30.00 on average but that is still a mighty large chunk of money.It is even larger when you look at what the doctor gets paid. (I told you earlier we would get back to this.) Don’t look at what the doctor bills, Look instead at your EOB, Explanation of Benefits that comes in a few months down the road. Don’t get caught up in the coding and insurance gibberish but instead look good and hard at the amount that was paid to the doctor. In many cases it will be something around $50.00, up to very rarely, $100.00.So the doctor paid out $30.00 to $45.00 to collect $50.00. Does that sound right or even smart?Then there are the processing costs added on at claims departments at the insurance companies. Most companies have at least two tiers of bureaucracy to look at every claim. The highest cost of any division at the large health insurance companies – right after management – is the claims department.The new health care reform law (Patient Protection and Affordable Care Act )has added no less than 159 new programs, agencies and departments in between your visits and your doctor getting paid. Anyone out there really think all of those programs will save your health care dollars for health?