Who Pays for Home Health services?
Home health care is an earned benefit as a part of Medicare and is also covered by most insurers.
Home health services can also be paid for directly by the patient and his or her family members.
Medicare: Most Americans older than 65 are eligible for the federal Medicare program. If an individual is homebound, under a physician's care, and requires medically necessary skilled nursing or therapy services, he or she may be eligible for services provided by a Medicare-certified home health agency. Depending on the patient's condition, Medicare may pay for intermittent skilled nursing; physical, occupational, and speech therapies; medical social work; home health aide services; and medical equipment and supplies. The referring physician must authorize and periodically review the patient's plan of care. The services the patient receives must be intermittent or part-time and provided through a Medicare-certified home health agency for reimbursement.
Medicaid: Administered by the states, Medicaid is a joint federal-state medical assistance program for low-income individuals. Each state has its own set of eligibility requirements; however, states are only mandated to provide home health services to individuals who receive federally assisted income maintenance payments, such as Social Security Income and Aid to Families with Dependent Children (AFDC), and individuals who are "categorically needy." Categorically needy recipients include certain aged, blind, and/or disabled individuals who have incomes that are too high to qualify for mandatory coverage but below federal poverty levels. Under federal Medicaid rules, coverage of home health services must include part-time nursing, home health aide services, and medical supplies and equipment. At the state's option, Medicaid also may cover audiology; physical, occupational, and speech therapies; and medical social services.
Private Insurances: Most all insurances provide for home health benefits. Please call us, our Patient Care Coordinator can help you determine if you have the coverage you need.
Self-pay: Home health services that fail to meet the criteria of third-party payers must be paid for "out of pocket" by the patient or other party. The patient and home care provider negotiate the fees.