Home health care coverage
Available under 65 and 65+
Most people would rather recover at home than in a facility. This coverage pays cash benefits to make that practical — without the price tag of full long-term care insurance.
The trend this is built around
Care has been moving in two directions at once: more preventive care to keep people healthy, and more recovery at home after a hospital stay, illness or injury. Medicare does cover skilled home health care under specific conditions, but it does not pay for the day-to-day help most families end up arranging themselves — an aide a few hours a day, adult day care, equipment for the house.
What a home health care indemnity policy pays for
- Home health care services and a home health aide
- Adult day care
- Home medical equipment
- Doctor calls at home
- Emergency room or urgent care visits
- Prescriptions
- Home hospice services
- Available extras on some designs: routine physical exams, eye exams with lenses and frames, hearing exams and hearing aids, dental exams
Benefit checks come to you unless you assign them to a provider, and they pay on top of anything else — including government-sponsored benefits. There are no deductibles or copays to satisfy first, no network restrictions, and coverage is guaranteed renewable, so it cannot be cancelled because you become critically ill.
Where the eligibility line sits
A medical exam generally is not required. But you typically cannot be accepted if you are already living in a nursing home or assisted living facility, or already receiving home health care services or similar benefits. In plain terms: this is coverage you buy while you are still independent. Once care has started, the door is usually closed.
Honest comparison to long-term care insurance
| Home health care indemnity | Traditional long-term care insurance | |
|---|---|---|
| What it pays | Set cash benefits for listed home-care services | Reimbursement toward a broad range of care, including facility care, up to a large pool of benefits |
| Premium | Considerably lower | Considerably higher |
| Scope | Focused on staying at home | Home, assisted living, and nursing facility |
| Underwriting | No medical exam typically; must be independent at application | Full medical underwriting |
This is not long-term care insurance and does not pretend to be. It is a partial answer at a price most people will actually pay, which is often better than the complete answer nobody buys.
Real-life examples
Home health care benefits start once your doctor certifies in writing that you need help with at least two everyday activities (bathing, dressing, eating, using the toilet, getting in and out of a bed or chair), or that you need supervision because of a memory condition like Alzheimer’s or dementia.
Dorothy recovers at home after a hip replacement
Dorothy, 77 · 6 weeks of recovery
After her surgery, Dorothy’s doctor certifies she can’t bathe or dress on her own for a while. She goes home instead of to a rehab facility. Over six weeks she has an aide five days a week, physical therapy twice a week, and four nurse visits, and she needs a walker and a shower chair.
| What the policy pays | Amount |
|---|---|
| Home health aide: 30 days × $50 | $1,500 |
| Physical therapy: 12 visits × $75 | $900 |
| Nurse visits: 4 × $100 | $400 |
| Walker and shower chair: up to $200 each | up to $400 |
| Paid to Dorothy | up to $3,200 |
Good to know: this is paid on top of anything Medicare or her other coverage pays, and the check goes to Dorothy. She used part of it to pay her daughter’s gas for the daily drive over.
Frank goes to adult day care
Frank, 81 · early dementia
Frank’s doctor recommends an adult day program so he has supervision while his wife works part-time. He goes three days a week, at least four hours a day.
| What the policy pays | Amount |
|---|---|
| Adult day care: $75 a day, up to 90 days a year | $75/day |
| If he attends 90 or more days this year: 90 × $75 | $6,750 |
| Paid for the year (maximum) | $6,750 |
The catch: Frank’s wife bought this policy before he needed care. Once someone is already receiving home care or living in a facility, they usually can’t qualify. Conditions treated in the 6 months before the policy starts also aren’t covered until it has been in force for 6 months.
These are illustrative examples with made-up names. Dollar amounts come from one sample plan design and are shown only to explain how the benefits work. Your actual benefits depend on the plan and options you choose, your state, and the terms, limitations, exclusions and waiting periods in your policy.
See it in a package: John, 28, on Medicare Advantage: how hospital indemnity, specified disease and home health care pay him together after a stroke →
Where it’s available: Availability varies by state. Among the states we serve, home health care coverage is currently marketed in Arkansas, Georgia, Louisiana, Missouri, North Carolina, Ohio, South Carolina and Tennessee.
Common questions
Is this long-term care insurance?
No. It is an indemnity policy that pays set benefits for home health care services. It is not long-term care insurance and it is not a Medicare Supplement.
Do I need a hospital stay first to collect?
That depends on the policy’s benefit triggers. Some benefits are tied to a prior confinement and some are not — we will go through the specific triggers with you.
Can my family member be the paid aide?
Because benefits are paid to you in cash rather than to a network provider, families have real flexibility in how care gets arranged. Any restrictions are in the policy, so ask before you plan around it.
What if I already have someone coming in to help?
Then you may no longer be eligible. Eligibility generally requires that you are not currently receiving home health care services or living in a facility.
Talk through staying at home
If keeping a parent — or yourself — out of a facility is the goal, let’s look at what this covers and what it does not, before care is needed.
Keep reading
This page is educational and is not an offer of coverage or a recommendation of any specific policy. The policies described are individually underwritten supplemental (indemnity) insurance. They are not major medical coverage, not Medicare Supplement insurance, not long-term care insurance, and not “minimum essential coverage” under the Affordable Care Act. Benefits, benefit amounts, riders, availability and eligibility vary by state and are subject to the terms, limitations, exclusions, waiting periods and pre-existing condition provisions of the actual policy and its outline of coverage. Senior Benefits Hub is an independent insurance agency; licensed since 2013. Not affiliated with or endorsed by any government agency.