Visiting Angels is a franchise-based home healthcare organization that operates across the United States. While Medicare does help pay for some home health services, most of the care offered by Visiting Angels agencies falls outside of Medicare Part A and Part B coverage.
Read on to learn more about the services provided by Visiting Angels and what Medicare may cover if patients meet the eligibility criteria, Medicare-covered alternatives to this type of care, and additional options for Visiting Angels coverage.
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What Is Visiting Angels?
Visiting Angles has been providing in-home healthcare services since 1998. The organization is a Medicare-approved provider that offers customized care programs to help older adults navigate the challenges of living at home. Some of the company’s services include Alzheimer’s care, post-hospital care, fall prevention, and social care. These services are offered both full and part-time, depending on patients’ needs.
Effective home healthcare plays an important role in giving older adults the ability to age in place at home rather than moving to a long-term care or nursing facility. According to recent research, home-based care had a positive impact on patients’ satisfaction and their health-related quality of life. As a result, organizations such as Visiting Angels have grown in popularity as a way to help patients get the care they need without leaving home.
Without assistance, these services can be expensive. The cost of Visiting Angels in-home care can range from $35 to $50 per hour, depending on where you live.
Limitations on How Medicare Covers Visiting Angels
Home health services covered by Medicare include skilled nursing care, physical therapy, occupational therapy, and durable medical equipment. Services offered by Visiting Angels, meanwhile, tend to focus more on non-medical assistance. For example, Visiting Angels’ Alzheimer’s home care includes services such as wandering prevention, accompaniment to appointments, meal planning, and assistance with dressing and grooming. As a result, many of the services offered by Visiting Angels may not be covered by Original Medicare.
In some cases, Medicare may provide some coverage for Visiting Angels services. These include short-term care for conditions that will improve, doctor-prescribed care for recovery from an injury, and in-home hospice care. Overall, however, Medicare does not assist with the typical Visiting Angels cost per month.
Short-Term Care
Short-term care may be covered if patients have recently received medical treatment for an issue that will improve. For Medicare to cover this type of care, patients must have recently stayed in a hospital for three days or more, have received Medicare-approved follow-up care within 30 days of their hospital stay, and have obtained doctor certification for skilled care.
If all three criteria are met, Medicare pays for 100% of covered services for 20 days and a portion of these services for days 21 to 100. After day 100, patients are responsible for all costs.
Doctor-Prescribed Care
Patients may also be able to access similar social services that help with social, medical, emotional, or mental challenges after an illness or treatment. However, it must be declared medically necessary by a patient’s doctor as part of the recovery process.
If Medicare approves the services, there is no time limit on coverage as long as the patient’s doctor determines that they are still medically necessary and reorders these treatments every 60 days.
In-Home Hospice Care
For patients who have a terminal illness and less than six months to live, Medicare covers in-home hospice and respite care. Along with medical care, additional services covered services may include grief counseling, short-term inpatient care for pain management, and short-term respite care to help reduce the burden on family members or other caregivers.
If patients choose in-home hospice care, Medicare covers all costs except for copayments on prescription drugs. In exchange, however, patients (or their proxy) must sign a statement saying they understand that Medicare will stop covering all non-hospice care.
Eligibility Criteria
Several eligibility criteria determine whether a home health service may be covered by Medicare. First is that patients are “homebound,” meaning they have difficulty leaving home without help such as a cane, wheelchair, or walker, or their doctor has advised them to remain at home.
Next, the services must be medically necessary. To meet this criteria, patients must meet with a doctor, nurse practitioner, or other skilled healthcare provider who will conduct an evaluation and determine which services are needed. This care must then be ordered by a healthcare provider and provided by a Medicare-certified home health agency.
Depending on the current needs and medical condition of the patient, Medicare may cover a part-time or intermittent home healthcare aide. To be eligible, patients must already be receiving skilled nursing care.
It’s also worth noting that Medicare does not cover full-time home health care. If patients meet the eligibility criteria, Medicare may cover part-time (also called intermittent) care up to eight hours per day and 28 hours per week.
How Medicare Advantage Covers Visiting Angels
While Original Medicare offers limited coverage for Visiting Angels home care, Medicare Advantage plans (also called Medicare Part C) typically offer broader coverage benefits.
As a result, Medicare Advantage plans may include additional coverage for in-home health services such as emotional or social support, personal care services such as cooking or cleaning, or custodial services such as bathing, dressing, or using the bathroom.
There is no set standard of coverage for home health services under Medicare Advantage plans, so patients and their families should evaluate multiple plans to find a provider that offers the type of care they need.
Medicare-Covered Alternatives to Visiting Angels
Original Medicare does cover some home health services under both Part A and Part B. These services focus on medical care and must be ordered by a doctor or other health practitioner. Some Medicare-covered services include:
- Physical therapy: This type of care focuses on evaluating and treating physical injuries to help patients maintain current mobility and function.
- Part-time skilled nursing care: Skilled nursing care is covered on a part-time basis — less than seven days a week or less than eight hours per day — and for 21 days or less.
- Occupational therapy: Occupational therapy helps patients perform daily activities such as dressing or bathing.
- Home health aides: If patients are receiving skilled nursing care, they may also be eligible for a part-time home health care aide to assist with day-to-day tasks.
How to Find Coverage for Visiting Angels
Although Medicare does not cover most Visiting Angels services, patients may be able to find coverage with alternative options such as Medicaid, long-term care insurance, or veterans’ benefits. Here’s a look at what each option may cover.
Medicaid
Medicaid may cover home health services if patients can demonstrate a need for care, such as the need for assistance with the Activities of Daily Living (ADL). If approved, Medicaid covers services such as assistance with bathing, dressing, and eating, along with tasks such as cooking, shopping, and cleaning. It also covers skilled nursing care, respite care, and transportation.
Long-Term Care Insurance
Long-term care insurance is available from private insurance providers and is designed to take care of the costs of long-term healthcare. It may cover some or all of the home care services, depending on the plan.
Veterans’ Benefits
Veterans’ benefits may cover homemakers and home healthcare aides for veterans who need assistance with ADLs, live in isolated areas, or whose caregivers are experiencing significant burdens. These services can be used in combination with other home health services.
All in All
Is Visiting Angels covered by Medicare? In most cases, no. While there are exceptions for medically necessary recovery from treatment or illness or end-of-life hospice care, most social and home services offered by Visiting Angels are not covered by Original Medicare.
Alternatives such as Medicare Advantage, Medicaid, long-term care insurance, and veterans’ benefits may offer more coverage for Visiting Angels’ services, either in conjunction with or as a replacement for Medicare.