Frequently Asked Questions about Understanding Home Care Services

1. What is the difference between Medicare (Skilled) and private pay skilled services

There are two types of Home Health Care under skilled services to choose from that have many similarities. The term skilled care services are used interchangeably, one is provided under private pay and the other is under Medicare. Both type of skilled care can only be provided by trained professionals such as registered nurses, licensed practical nurse and certified nurse aide. These services are provided in the home under doctor’s orders. Medicare covers intermittent skilled care while Private Pay skilled services are not limited to intermittent care but can offer 24 hour coverage based on your needs.

2. What determines coverage under Medicare?

In order for Medicare or other insurance to cover home health care, there are generally four requirements that must be met

  • Care must be ordered and overseen by a physician
  • The patient must have been seen by a physician for the condition requiring home health care no more than 90 days prior to the start of home health care services.
  • The patient must be (home bound), meaning that leaving the home is unsafe and required assistance from other people.
  • The care needed must be skilled rather than custodial. Medicare only covers intermediate care for specific needs.

3. What is the difference between non-skilled agencies and skilled agencies?

Non-Skilled Home Care agencies are not medical but offered services provided by personal care workers trained to perform basic care only. The caregivers are not licensed staff and cannot perform skilled care and are not required to have any medical knowledge.

4. Why would I need private pay skilled services from Summer Cares?

Medicare provides short term intermittent care and the criteria for admission are changing making families take on the responsibility for ongoing care. Summer Care is a licensed medical agency providing;

  • Certified Nurse Aides can provide Skilled or Non-Skilled care services using all professional license staff.

  • We provide 24 hour care or just a few hours as long as you need the services.

  • Certified Nurse Aides has the training and knowledge to perform skilled care working under the supervision of a Registered Nurse.

  • Skilled agencies can offer the peace of mind knowing when unexpected illness occurs you have the professional staff available including; skilled nursing for medication management, would care and much more.

5. How expensive is private pay skilled care services? And is it covered under long term private insurance?

It is about the same cost for a Certified Nurse Aide to provide care versus a non-skilled personal care worker. We bill long term private insurance but most follow the same criteria as Medicare requirements as stated above. Nursing services are provided if you need the skills of a Nurse for one time visit or on-going at affordable rates.


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