Home healthcare services may be paid for directly by the patient or family, through private insurance coverage, or through other sources. Many hospice care programs are given to the patient regardless of the patient's ability to pay. Most costs for hospice are covered by Medicare. Always check with your insurance provider regarding terms of coverage. The following are sources of payment for home healthcare services:
If a patient does not meet the requirements of third-party payers, he or she may have to pay for home healthcare services. Self-pay is not a choice for many Americans.
Public third-party payers
If you are older than 65, you are likely eligible for Medicare. People who are unable to be active outside the home, under a healthcare provider's care, and in need of skilled nursing or therapy may also be eligible for Medicare. A healthcare provider must authorize and at different times review the home healthcare plan of the person. Home healthcare services covered by Medicare must be part-time. It must also be provided by a Medicare-certified home health agency, or an agency that meets the minimum federal requirements of care and cost. Hospice care coverage by Medicare requires certification from a healthcare provider that the patient is terminally ill.
Medicaid is a joint federal-state medical assistance program for low-income individuals. Eligibility differs from state to state. However, all states are required to provide home healthcare coverage to people who:
Get federally assisted income maintenance payments, like Social Security or Temporary Assistance for Needy Families.
Are determined to be "categorically needy." Categorically needy refers to people who are aged, blind, and are disabled with incomes too high to qualify for coverage below the federal poverty level. Under the federal Medicaid rules, coverage of home health programs must include services, like part-time nursing, healthcare agency services, and medical supplies and equipment. Some states may provide audiology, physical, occupational, speech therapies, and medical social services as well. Medicaid hospice care coverage is essentially the same as Medicare.
Other third-party payers
Older Americans Act. The Older Americans Act funds state and local social service programs for frail and disabled older people so they can continue independent living in their communities. Coverage may include home healthcare agencies, personal care, and assistance with chores, meals, and shopping. Individuals must be ages 60 and older. This act expired in 2011. The Older Americans Act is challenged with budget cuts and rapid growth in the older population. The Older Americans Act Reauthorization Act was signed into law on April 19, 2016.
Veterans Administration. Home healthcare is given for veterans through the Veterans Administration if the person is at least 50% disabled as a result of a service-related injury or illness. Authorization from a healthcare provider is needed. Services must be given through the Veterans Administration's hospital-based home care units. Nonmedical home healthcare services are usually not covered under this provision.
Social services block grant programs. On a yearly basis, federal social services block grants are awarded to the states for service needs. Some of these funds are given to home healthcare agencies and homemaker or chore worker services. Contact the state health departments and offices on aging for more information.
Community organizations. Some community organizations may pay for all or part of the necessary home health or hospice care services. This depends on a patient's eligibility and financial circumstances.
Private third-party payers
Commercial health insurance. Most commercial health insurance policies typically cover some home healthcare services for immediate or acute medical needs. However, coverage for long-term services varies from plan to plan. Sometimes commercial insurance companies will pay for skilled professional home healthcare under a cost-sharing plan.
TRICARE. Formerly known as CHAMPUS (Civilian Health and Medical Program of the Uniformed Services), TRICARE covers certain home healthcare in a cost-sharing plan to dependents of active military personnel and military retirees. It also provides a hospice benefit to its terminally ill beneficiaries. This benefit may provide nursing, social work services, therapies, personal care, medicines, and medical supplies and equipment.
Workers' compensation. If a person needs medical home healthcare services as a result of an injury on the job, he or she may be eligible for coverage through a workers' compensation plan.
Managed care organizations. These are group health plans that may cover home health and hospice care services. Managed care organizations contracting with Medicare must provide the full range of Medicare-covered home health and hospice services that are available. These organizations must be approved ahead of time.