Highmark Home Care Coverage in Pittsburgh

What Kind of Home Care Does Highmark Cover?

Highmark is one of the largest insurers in Pennsylvania, and many Pittsburgh-area families rely on it for their parent's coverage. The key thing to understand is that there are several different Highmark plan types, and each one handles non-medical home care differently.

• Highmark Medicare Advantage (HMO and PPO plans): Some Medicare Advantage plans include a supplemental home care or personal care benefit beyond Original Medicare. This may cover a set number of hours per week for help with activities of daily living — things like bathing, dressing, grooming, and meal preparation. The specifics change from year to year and plan to plan.
• Highmark Medigap / Medicare Supplement plans: These plans follow Original Medicare rules closely. Original Medicare generally does not cover custodial, non-medical home care. A Medigap plan fills gaps in what Medicare pays for skilled care, but it does not typically add a non-medical home care benefit on its own.
• Highmark commercial / employer-sponsored plans: Most employer group plans do not cover custodial home care. Some may cover a short-term home health aide benefit following a hospitalization, but that is usually tied to skilled nursing or therapy needs — not ongoing companion or personal care.

The bottom line: call the member services number on the back of the Highmark card and ask specifically about "custodial home care," "personal care," or "non-medical home care" benefits. Ask whether pre-authorization is required and what documentation is needed.

What Non-Medical Home Care Actually Includes

It helps to know exactly what you are asking about when you call Highmark. Non-medical home care — the kind Mary Angels provides in Pittsburgh and throughout Allegheny County — covers:

• Personal care: bathing, dressing, grooming, toileting, and mobility assistance. Learn more about Personal Care in Pittsburgh.
• Companion care: conversation, accompaniment to appointments, and meaningful engagement to ease loneliness. See Companion Care in Pittsburgh.
• Homemaker services: light housekeeping, laundry, errands, and meal preparation. See Homemaker Services in Pittsburgh.
• Respite care: temporary relief for a family caregiver. See Respite Care in Pittsburgh.
• 24/7 and live-in care: around-the-clock support for higher-need situations. See 24/7 & Live-In Care in Pittsburgh.
• Transportation: rides to medical appointments, grocery stores, and social activities.

None of this involves nursing, wound care, injections, or any clinical procedure. Mary Angels caregivers do not perform medical tasks.

What to Say When You Call Highmark

Many families feel nervous about calling their insurance company. Here are the specific questions to ask the Highmark representative:

1. Does my plan include a non-medical home care or custodial care benefit?
2. Is there a personal care or home assistance supplemental benefit (common in some Medicare Advantage plans)?
3. How many hours per week or month are covered, and is there a dollar cap?
4. Do I need a physician order or prior authorization before services begin?
5. Does the caregiver agency need to be in-network, and if so, how do I verify that?
6. Is there a copay or coinsurance for each visit?

Write down the representative's name, the date, and a reference number for your call. If they say something is covered, ask for it in writing.

Other Ways Pittsburgh Families Pay for Home Care

If Highmark does not cover the care your parent needs, you are not out of options. Pittsburgh families use several other funding paths:

• Pennsylvania Medicaid (Community HealthChoices): If your parent has both Medicare and Medicaid, the Community HealthChoices (CHC) waiver can pay for non-medical home care. Read more on our PA CHC Medicaid Waiver Home Care page.
• Long-term care insurance: A separate long-term care policy — not Highmark health insurance — often covers custodial home care directly. See Using Long-Term Care Insurance for Home Care.
• VA benefits: If your parent is a veteran, VA Aid and Attendance may help. See VA Aid & Attendance for Pittsburgh Veterans.
• Private pay: Many families in Pittsburgh and Allegheny County pay out of pocket. Our Home Care Costs in Pittsburgh page explains what to expect.

For a full overview of all payment options, visit our How to Pay for Home Care in Pittsburgh guide.

How Mary Angels Can Help You Navigate This

Sorting through insurance benefits is stressful — especially when you are already worried about your parent's safety and wellbeing. Mary Angels Home Care has been serving Pittsburgh families since 2022. We are a family-owned, women-owned, PA-licensed non-medical home care agency, and we are used to helping families figure out the funding picture before we ever start care.

When you call us at 412-900-9354 or email info@maryangelshomecare.com, we will schedule a free in-home assessment — no obligation, no pressure. We will listen to what your parent needs, explain exactly what our caregivers do (and do not do), and help you understand your options. Most families in Allegheny County go from first call to first visit within 48 hours.

We serve more than 20 Pittsburgh-area neighborhoods, from Shadyside and Squirrel Hill to the North Hills and Mt. Lebanon. Wherever your parent lives, we can help.