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Home Health Care: Who Pays for What?

There are five major sources of payment for home health care: self-pay, Medicare, Medicaid, insurance, and community service programs.

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Home health agencies must give you a notice that explains why and when they estimate Medicare will stop paying for your mom or dad's home health care. If you believe your parent needs continued home health care, you can appeal the decision. Ask the home health care agency for the 800 number of the regional home health intermediary. If you want to take the risk, you can still receive home care services and pay the agency directly. If you win the appeal, Medicare will reimburse you.

  1. Medicare usually covers your mom or dad's home health care if your parent is homebound, under a physician's care, and requires medically necessary skilled nursing or therapy services. A physician must order these services for Mom or Dad. Medical equipment and supplies along with different therapies are also covered under the Medicare home health benefit. The services must be intermittent, meaning part-time. The rules governing home health care benefits change frequently, so check in often with the Web site at www.medicare.gov. You can track down the home health care intermediary's phone number for your region at the site.
  2. Medicaid is a joint state-federal medical assistance program for people with low incomes. Because Medicaid is state administered, each state has its own rules and benefits governing home health care benefits. The best way to determine if your parent qualifies for programs in your state is to contact the local area agency on aging or your local welfare office.
  3. Various insurance programs will cover home health care, but you really have to read your policies well. Some Medi-gap policies offer at-home recovery services when the policyholder is receiving Medicare-covered skilled home health services, but it must be ordered by your mom or dad's physician. This type of coverage is often used to help your parent recover from surgery or an acute illness. Long-term care insurance policies also offer home health care services, but plans vary widely, with different sets of requirements. If your mom or dad has such a plan, read it carefully before bringing in home health care services.
  4. Medicare managed care plans must offer the same exact benefit that original Medicare provides. Some plans offer more than Medicare; again, read the policies carefully.
  5. The Veterans Administration will provide home health care services to veterans who are at least 50 percent disabled due to a service-related condition. A physician must authorize the service, and the care is delivered through the VA's hospital-based home care units. Homemaker services are not covered.

Community organizations do offer a number of home health care services to assist families' care for a loved one at home. Some states offer family caregiver support programs through their area agency on aging. Faith-based groups offer companion services and homemaker services, and some home health care agencies offer care at reduced rates for low-income persons. Check with the area agency on aging to find out what's available in your community and state.

More on: Aging Parents


Excerpted from The Complete Idiot's Guide to Caring for Aging Parents © 2001 by Linda Colvin Rhodes, Ed.D. All rights reserved including the right of reproduction in whole or in part in any form. Used by arrangement with Alpha Books, a member of Penguin Group (USA) Inc.

To order this book visit the Idiot's Guide web site or call 1-800-253-6476.


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