Different insurances provide varying coverage for home-care services. We have general guidelines about the most common types of insurance and the coverage they generally provide. If you prefer, we would be happy to contact your insurance company to find out what your specific plan covers for home-care services.
The most common insurances seen by Community Nursing Services are:
Medicare pays for professional home care services for senior citizens if they meet fairly strict criteria. Medicare covers nursing and physical, occupational and speech therapy services. It will also cover home health aide services if nursing or therapy service is present. Medicare does not cover companions or homemakers.
Medicaid is a joint federal-state medical assistance program for low-income individuals. States are required to provide home health services to individuals in certain categories such as aged, blind or disabled. Medicaid covers nursing care, home health aide care and limited therapy
Medicare Advantage plans are managed care plans for seniors. Managed care plans often include coverage for home health care services. HMOs usually require prior authorization for home care and the use of a home care agency that participates in the HMO network.. These plans provide the same benefits as regular Medicare including home care, but many plans require prior authorization for home care services.
Private health insurance typically covers some home care services for acute needs. Benefits for longer term care vary by plan. Most private plans will cover professional home care services with the patient responsible for cost-sharing. Prior approval is usually required, especially for managed care plans.
Home care services that do not meet the criteria of insurers or government programs must be paid "out of pocket" by the patient or family.
Federal funds to state and local agencies help provide home care services for individuals over age 60 who are at risk for placement in an institution and who meet income and eligibility guidelines. The Home Care Program provides professional case management and coverage for nursing, therapy, home health aide, homemakers, telemonitoring and medical alert services
Veterans who are at least 50% disabled due to service-related conditions are eligible for home care. A physician must authorize these services.