Individuals covered by either private insurance or government-funded programs for home health care must understand their coverage options, eligibility criteria and associated costs in order to make informed decisions about which types and quantities of home health services they need. Healthcare professionals as well as their insurance provider should also be consulted in order to fully comprehend any details and limitations in coverage that may affect them.
Private health care insurance can often be an attractive solution to pay for home health care services, particularly if the cost is being covered by either an employer or marketplace/exchange premium tax credit subsidies. Coverage amounts and limits depend upon each plan; depending on its terms, private insurance can cover some or all home healthcare expenses.
Medicare and other private health plans generally cover home health care services that have been prescribed by a physician or considered medically necessary, which usually depends on the nature and severity of a condition in the patient. Some plans may limit coverage for home health aides or require them to be provided through an agency.
As well as Medicare and private insurance policies, other public-funded programs like TRICARE or Medicaid can also provide limited home health care benefits to certain individuals. TRICARE covers home healthcare for active military members and their families, veterans, nurses, social work services, therapies and supplies via cost sharing plans; hospice care is also provided in these instances. Medicaid programs vary by state and provide home health care benefits to seniors meeting eligibility requirements through skilled nursing, physical therapy services and home health aides as well as medication management and meal delivery.
Individuals may also pay for home health care on their own using funds from personal savings, retirement accounts, investments or pensions. Other possible funding sources may include community benefit waivers administered at the state level to provide financial assistance for low-income individuals requiring home health care services.
As well as Medicare and private insurance policies, some states also offer Medicaid programs which cover home health care as part of an overall program known as Home and Community Based Services waivers. These programs are administered at the state level and provide coverage for seniors whose incomes fall at or below 133% of the Federal Poverty Level. Private insurers also provide coverage that does not meet Medicaid waiver eligibility, but these plans typically come with large out-of-pocket expenses and coverage is usually limited. Individuals considering private health insurance should review each plan’s Summary of Benefits and Coverage before selecting one. Short-term plans often offer lower premiums with minimal out-of-pocket expenses.