Home Care services can be very expensive. It is usually paid for directly by the senior or senior’s family. However, there are various private sources such as insurance companies and public sources like Medicare, Medicaid and Veterans Administration that will pay for home care services.
In This Home Care Article:
Home care is the term used for senior care services that are provided in the comfort of the senior’s home. Home care services are suited for seniors who need on going care but prefer to stay at home. Usually, home care services are given to seniors who are chronically ill or to seniors who need help with activities of daily living such as eating, bathing, dressing, toileting and light house chores.
Generally, private and public sources will only cover home care services when home care is considered medically necessary. Private insurance companies will have different policies on home care services. This is the reason why it is important to call the insurance company to check your home care coverage. If the private insurance company does not cover home care services, seniors will have to pay out of pocket or can contact private agencies that can provide assistance to seniors who cannot afford home care services.
1. Self- Pay
The senior and/or senior’s family will have to pay for the home care service if the senior does not have any health insurance coverage or if the senior’s health insurance does not cover the home care services that the senior needs.
2. Commercial Health Insurance Companies
Typically private insurance policies cover some types of home care service. Be sure to thoroughly check your health insurance policy for home care coverage as it may vary from plan to plan.
Commercial health insurance companies will usually pay for skilled professional home care service with a cost-sharing provision. Some people choose to purchase long term care insurance for additional home care coverage.
3. Managed care organizations
Managed Care Organization is a group of health care providers who have contracts with health insurance plans to provide a wider range of health care services. The Health Maintenance Organization, commonly known as HMO is the most popular form of a managed care organization.
Managed care organizations may sometimes cover home care services. However, coverage may be limited. Managed Care Organization limits the subscriber’s choice of health care providers including physicians and medical facilities. Be sure to ask about your plan’s coverage to find out whether home care services will be covered or not.
4. Workers Compensation
Individuals who require home care services due to an on the job injury or becomes sick as a result of work is eligible to receive home care service benefit through worker’s compensation.
1. Medicare Home Care Benefit
In General, American citizens who are 65 years old and over may qualify for Medicare Home Care benefit. However, some people who are below 65 years old may also qualify for Medicare due to disability. To be eligible for Medicare Home Care benefit, the Medicare beneficiary must meet all of these requirements:
- A physician must prescribe home care.
- Your Physician must have a care plan for you, which needs to be reviewed regularly.
- Home care services must include part time skilled nursing care, occupational therapy, speech-language therapy or physical therapy.
- The patient needs to be homebound and not capable of leaving the house without any help.
2. Medicaid Coverage For Home Care/Home Health Services
Medicaid is a joint federal and state medical assistance program administered by the states for needy or low income individuals. Eligibility and benefits will depend on the requirements set by each state.
Medicaid will pay for some home care coverage if the individual meets the low income and limited asset test in his or her state. The services must be ordered by a doctor as part of the patient’s plan of care, which should be reviewed regularly and should take place at the recipient’s residence.
In general, Medicaid coverage of home health services include the following:
- Part-time nursing by a home health agency
- Home health aid services by a home health agency
- Medical supplies and equipment
- Physical, occupational and speech therapy
Please note only Medicaid licensed facilities qualify for reimbursement. To find out more about Medicaid Coverage for Home health services, check your Medicaid Coverage
3. Department of Veterans Affairs Benefits
According to the Veterans Administration, Home care will be provided to Veterans who are at least 50% disable due to a service-related condition. Although the Veterans Administration does not directly provide skilled home care services, the VA has contracts with home care agencies in the community to provide quality home health care services to veterans. However, in order to qualify for reimbursement, the following conditions must be met:
- The VA doctor must refer the veteran.
- The veteran must meet the medical requirements set by the VA for skilled home care benefits.
According to the Veterans Administration, home health care services for eligible veterans include:
- Homemakers for shopping, cleaning or meal preparation
- Home Health Aides for help with bathing and dressing
- Nursing assistants for bathing
- Nurses to help you with your medications and dressing changes
- Physical therapists to help you with strength and mobility exercises
- Occupational therapists to help you re-learn activities like eating, dressing, etc.
- Speech therapists to help you with re-learning to speak following surgery or a stroke.
If you have questions about eligibility and benefits, contact your VA primary care provider or VA social worker. You can also visit the Veterans Administration website at: VA Benefits
4. Social Services Block Grant Programs
Every year the Federal government provides social services block grants for state-identified social services needs. Each state usually allocates part of the funds for home care aid and homemaker services. To get more information about this government program, contact the state Health Department or local Agency on Aging.
5. Older Americans Act (OAA)
The Older Americans Act, known as the OAA, allows state and local programs to help frail and disabled older people to maintain their independence in their communities. OAA is funded by the federal government to help cover for Home Care aides, personal care, house chores, meal delivery, escort and shopping services for older individuals who are 60 years of age and older. Contact your, local Agency on Aging to find out more about this benefit or visit Administration of Aging Website
6. Community Organizations
There are some community organizations who help older adults pay for home health and personal care services. These community groups may pay for the full or partial cost of home health services depending on the older adults eligibility including financial status. Contact your social workers, hospital dischargers, the United Way and local offices on aging to get more information about senior benefits offered by local community organizations in your area.
7. Civilian Health and Medical Program of the Uniformed Services
Previously known as CHAMPUS, the Civilian Health and Medical Program of the Uniformed Services has been renamed to TRICARE. This Medical program is federally funded and provides benefits for dependents of active military personnel and military retirees and their dependents and survivors. Benefits covers for skilled nursing care and other professional medical home care services.
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