Who Pays for my Home Care Services?

Home care may be paid by a variety of sources.  Benefits vary greatly depending on the policy purchased or the eligibility of the client.  Sources of home care payment include:

Private Pay

Home care service can be privately purchased.  The scope and limits are negotiated between the client and the agency.  Some agencies offer a sliding fee scale based on the client’s financial ability to pay.

Private Health Insurance

Each policy varies for the client’s ability to qualify for services.  Generally, private insurance is restricted to covering primarily skilled services authorized by a physician.  Insurance coverage needs to verified and requires prior-approval to ensure the best possibility of payment.

Medicare

In order for Medicare to cover home care services, the client must be under a physician’s care, be eligible for Medicare, be homebound, in need of a part-time, or intermittent need of skilled nursing or occupational/physical/speech therapy.  If eligible, the client may receive skilled nursing, therapy, home healthaide, medical social work, and durable medical equipment and supplies.  Prior hospitalization is not necessary to qualify.  Services are usually covered for a short duration with exceptions of hospice care for the terminally ill and other extenuating illnesses.

Medical Assistance

This federal/state administered medical assistance program provides similar services as Medicare for those of any age that financially qualify and have been declared disabled.  Individuals do not need to be homebound but must be under a physician’s care.  Services may range from 24 hour per day care, to intermittent custodial homemaking needs.  Individual care plans are authorized and provided based on needs and the severity of the illness.

Waivered Programs

For the elderly, children, developmentally disabled or disabled and handicapped adults.

Waivered programs are available for those that meet specific financial and physical definitions of chronic needs for care.  Waivers may not claim the parental or spousal income in order to provide the services for an individual client.  Authorization for this service is made by a county social services/public health screening team.  Services may include skilled nursing, home healthaide, homemaking, home delivered meals, respite care, companionship, rental of an emergency response system, or adaptive medical equipment and supplies.

Worker’s Compensation

Following an injury or accident, home care services may be ordered for rehabilitation and recovery.  Each insurance company has information on the policy coverage.  Services provided vary upon the policy and nature of injury or illness.

Veteran’s Benefits

A veteran may be eligible for home care services through authorization of skilled and custodial services. Often the order for home care services is made through a Veteran’s hospital or clinic.

Service Block Grants

In some communities, specific services through grant programs and volunteer support are available. Typically, they include custodial services, volunteer transportation, meal prep and grocery shopping, companionship and respite care.