More than ever before, patients and their families want more ownership and control of their own health. For many, home health care is a safe and affordable solution that allows loved ones to obtain the crucial care they need in the safety and comfort of their own homes. Just as there are a number of services and providers of in-home care, there is also a variety of options for covering the cost of care.
Medicare Home Health Benefits
Medicare is among the largest payors of home health care services. To qualify, you must be 65 years of age or older, or be defined as disabled for two years for Social Security purposes. Medicare home health benefits are intended to manage a chronic condition, assist recovery from an illness or injury, or help with other intermittent, short-term needs. It covers the spectrum of care services, from skilled nursing and therapy to personal care and companionship (in specific cases). A doctor’s referral for all services is required. The full-summary of Medicare home health benefits can be found here.
How Many Hours of Home Health Care Does Medicare Cover?
Home health aide services and skilled nursing care are covered by Medicare’s home health benefit up to seven days a week for no more than eight hours a day, and 28 hours a week. If additional care is required beyond these parameters, up to 35 hours of care per week may be provided on a case-by-case basis.
Medicaid Home Health Benefits
All states have government programs that provide medical assistance to individuals who meet income eligibility requirements. You may meet Medicaid requirements if your home is your main asset and your primary source of income is Social Security. Certain states expanded Medicaid coverage for low-income adults. Medicaid eligibility varies from state to state, but general eligibility information can be found here.
You may qualify for Veterans Administration (VA) health care benefits if you served in the military, or were called to active duty while a member of the National Guard. Eligibility for VA health care benefits is determined on an individual basis, based on the patient’s need for ongoing treatment, assistance, and personal care. The Veterans Administration may also consider factors such as existing insurance coverage, disability status, ability to pay, and income level. More detailed information on VA health benefits eligibility can be found here.
Private Health Insurance
Private health insurance policies vary widely, so it is important to review your specific policy to best understand your benefits. Most private insurance companies cover the costs of short-term nursing care following an injury or surgery not directly related to a motor vehicle accident or workers’ compensation issue. Tax advantages may be available to high-deductible plans tied to health care savings accounts.
Long-Term Care Insurance
While Medicare and Medicaid help patients afford some of their medical costs, they may not cover extended illnesses or disabilities. Long-term health insurance helps people pay for a variety of long-term care needs, such as nursing homes and in-home care. It will likely be difficult to enroll in a long-term insurance policy if you are currently in poor health or require long-term care. Check with your insurer to learn more about the plans and premiums available.
Sometimes, recipients of in-home services choose to pay for their home health care expenses out of pocket. Home equity, stocks, savings, retirement income, or family gifts can all be used to cover the cost of home health care. If you are considering paying out-of-pocket for your care, discuss your options with a financial advisor or attorney first. Many health care agencies are willing to work out a payment plan with you.
If you have injuries that are related to a workplace accident or motor vehicle wreck, auto insurance or workers’ comp benefits may pay for your home health care services.
Questions To Ask Your Home Health Care Provider
A good way to determine if a home health provider is the right fit for you or your loved one is to meet personally with a representative to discuss your questions and concerns in a frank, one-on-one conversation. Some questions to consider for this meeting include:
- If I choose to pay privately, what forms of payment do you accept?
- Do you accept my health insurance, and do you process payment directly from them?
- What is the full range of your services?
- Can you provide references from patients and their families?
- How do you ensure, monitor, and maintain quality?
- Who will coordinate care and be my point of contact?
Contact Us Today
There are a number of options available to help cover the cost of home health care. Discuss your options today.