Home health care may be paid by various sources. The main payment sources include Medicare, Medicare, private health insurance, Veterans Administration, Workers Compensation, Health Maintenance Organizations (HMO), managed care plans, or individual patients and families.
The following is a brief summary of various payor sources:
For those 65 and over, this federal health program pays for skilled home health services, some kinds of aide services and agency-provided medical supplies and equipment if the patient meets certain requirements. The patient must be under a physician's care, require a taxing effort to leave home and in need of part time or intermittent skilled nursing care, or physical, speech or occupational therapy. Once the patient meets those requirements, he/she is eligible for a range of services.
Medicare Advantage Plans
Insurance companies with Medicare contracts must provide the full range of Medicare covered services that are available, including home health. Coverage is usually limited to physician-directed medical services and therapy. There may be more limitations to care related to services provided. Some agencies and physicians do not accept some advantage plans.
This program assists low income patients through a joint federal-state program administered by the state. Each state has its own set of eligibility requirements. Once the patient qualifies for Medicaid and the service is deemed medically necessary, the patient may receive skilled nursing, physical therapy, home health aide services and personal care.
Patient/Private Pay/Private Health Insurance
Home care services and expenses can be paid from out-of-pocket sources. The services and the payment are worked out ahead of time between teh family and the agency. Generally, private insurance coverage is limited to physician directed medical services such as skilled nursing and therapy and medical equipment.
Veterans with a 50% or more service-connected disability are eligible for home health care coverage. Services must be authorized by their physician and the Veterans Administration.
Any person needing home care services as a result of injury on the job is eligible. Workers' compensation representatives have information on eligibility.