ArcaMax

Dear Toni:

My mother, Doris, had a heart attack in February and was in the hospital for over a week, with a short stay in a skilled nursing facility until she regained her strength. She needed additional care at home, and her cardiologist ordered home health with a nurse who comes to her apartment at the assisted living facility only once a week for about 20 minutes.

I asked her cardiologist and manager of the assisted living facility to order a nurse or aide through her Medicare home health benefits for a minimum of an eight-hour daily stay. I was shocked to learn that Medicare would not approve any additional time for home health.

Now, my mother must pay for home care herself, which is provided by the assisted living facility, costing an extra $1,000 a month in her rent. Please explain what home health is and how to find the right home health company when there is a medical need.

Thanks,

Steffanie from Boston

Steffanie:

The medical care that Medicare pays for is skilled nursing in a facility, which Doris used after she left the hospital. With skilled nursing, the first 20 days are at no cost, with days 21-100 costing $217 per day as of January 1, 2026. After day 100, one pays 100% out of pocket.

Page 43 of the 2026 Medicare & You Handbook explains “Home health services.” The handbook states, “Medicare covers home health services under Part A and/or Part B. Medicare covers medically necessary part-time or intermittent skilled nursing care.” The handbook does not say full-time, and that is where your problem begins, Steffanie. Your mother, Doris, needs additional care because she has a serious health issue and is homebound.

Steffanie, because of your mother’s health issues, she will still be receiving the home health services as long as Doris meets the medically necessary qualifications. I personally am having a Medicare home health problem because my younger sister had a high blood pressure issue that may cause a stroke and home health was ordered. Last week, the home health agency had to appeal Medicare’s decision not to continue the home health visits.

I understand that trying to find the right home health agency can be difficult. Below is information that The National Association of Home Care suggests asking to help narrow the search for a home health agency:

Do not forget that there must be a medical need for Medicare to pay for the services provided by a home health company. Medicare does not pay for custodial care such as making sure your family member has a daily bath, gets dressed or is ready to go to bed. You will pay for custodial care on an hourly basis, which is what your mother is having to do, Stephanie.

To order home health is not complicated:

—A doctor must order home health and sign the plan document that the doctor’s office sends to Medicare.

—The home health agency schedules a face-to-face meeting with the patient and family members to develop what care and services are needed.

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

—The 60-day recertification periods last if she is improving, and her doctor must sign again to authorize the recertification periods.

—Home health includes nursing care, physical therapy and other medical needs for Medicare recipients who are “homebound.”

The average person is not aware of the services they can receive from Medicare such as home health that can help to enhance their recovery at home.

For a Medicare checkup, call the Toni Says Medicare hotline at 832-519-8664 or email info@tonisays.com. Toni’s Medicare books are available at www.tonisays.com with a bundle discount.

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Toni King is an author and columnist on Medicare, Social Security and long-term care issues. She has spent nearly 30 years as a top sales leader in the field. If you have a Medicare question, email info@tonisays.com or call 832-519-8664. Sign up for the Toni Says newsletter at www.tonisays.com to keep up to date on Medicare changes.

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Copyright 2026 Toni King, Distributed by Counterpoint Media