Who pays for Homecare? Medicare, Medicaid, Commercial Insurance
and Private Pay are all possible payment sources for home health care
services.
MEDICARE Medicare covers 100% of home health charges
if the patient meets the following conditions:
1. The patient is eligible for Medicare coverage.
2. The home health services are ordered by the patient's physician.
3. The patient is essentially homebound.
4. The patient requires skilled care.
5. The patient requires intermittent care.
Terms:
Homebound: A patient is considered homebound if he
or she experiences a normal inability to leave home. The patient's
physical condition and/or physical limitations are such that
it would be a considerable and taxing effort for the patient
to leave home.
Skilled Care: For home services to be covered by Medicare
under either Part A or Part B the patient must need at least
one of the following services:
If one of the above services are providing care, then the
patient may also receive Occupational Therapy, Medical Social
Services, and Home Health Aide care as needed. Necessary medical
supplies and durable medical equipment may also be covered.
Intermittent: A patient must have a medically predictable
recurring need for skilled services. Generally this means at
least one visit every sixty days.
Patients who qualify for home health under
Medicare are never billed for services personally. Medicare
does not cover homemaker/companion services.
MEDICAID Medicaid generally follows the same guidelines
as Medicare. However, questions regarding an individual's specific
coverage should be directed to Heritage Home Healthcare staff before
services begin.
LONG TERM CARE INSURANCE Long Term Care Insurance generally pays for home healthcare. Depending
on your policy and provider you may be assigned a case manager to
oversee your care. You generally will need a doctor's note specifying
that you need help with several ADL's (activities of daily living)
to begin a claim. You will have a choice of home healthcare agencies
at the time that your claim is approved.
COMMERCIAL INSURANCE Commercial health insurance policies typically
cover home care however benefits vary from plan to plan. Heritage
has a helpful and knowledgeable staff to assist in determining coverage
with insurance companies and the procedures involved to bill for
those services. The patient is responsible for deductible or non covered
services and payment arrangements can be made directly with Heritage
for this self pay piece.
PRIVATE PAY Home care services that fail to meet the criteria
of third party payors must be paid for "out of pocket" by the patient
or other party. Heritage does require a deposit that will be applied
to the last months charges on termination of services.
