Home Health

Paying for Home Health and Hospice Care

Paying for care:

Home health care services may be paid for directly by the patient, through insurance coverage, or through other public or private sources. Most hospice care programs are provided to the patient regardless of the patient's ability to pay. Always check with your insurance provider regarding terms of coverage. The following are sources of payment for home health care services:

self-pay
If a patient does not meet the requirements of third-party payers, he/she may have to pay for home health care services.

public third-party payers

Medicare - If you are older than 65, you may be eligible for the federal Medicare program. Patients who are homebound, under a physician's care and in need of medically necessary skilled nursing or therapy may be eligible for Medicare coverage. A physician must authorize and periodically review the home health care plan of the patient. Home health care services covered by Medicare must be intermittent or part time and provided by a Medicare-certified home health agency (an agency that meets the minimum federal requirements of care and cost). Hospice care coverage by Medicare requires certification from a physician.

Medicaid - Medicaid is a program for low-income individuals that is operated jointly by the federal and state government. Eligibility varies from state to state. However, all states are mandated to provide home health care coverage to people who:

Receive federally assisted income maintenance payments such as Social Security income or Aid to Family with Dependent Children (AFDC).

Are deemed "categorically needy" (individuals who are aged, blind, and/or disabled with incomes above the mandatory coverage level but below federal poverty levels). Medicaid programs must cover home health care services such as part-time nursing, health care agency services, and medical supplies and equipment. Some states require the program to cover audiology, physical, occupational, and speech therapies and medical social services as well. Medicaid hospice care coverage is generally the same as Medicare.

Older Americans Act (OAA) - The Older Americans Act, enacted by Congress in 1965, funds state and local social service programs for frail and disabled older individuals to continue their independence in their communities. Coverage may include home health care agencies, personal care, meals, and shopping, to name a few. Individuals must be 60 years of age or older.

Veterans Administration - Home health care is covered for veterans through the Veterans Administration if the individual is at least 50 percent disabled due to a service-related injury or illness. Authorization from a physician is needed. Services must be provided through the Veterans Administration's hospital-based home care units. Nonmedical home health care services are usually not covered.

Social Services Block Grant Programs - Federal social services block grants are awarded to the states each year for service needs. Some of these funds are allocated to home health care agencies and homemaker or chore worker services.

Community Organizations - Depending on a patient's eligibility and financial circumstances, certain community organizations may pay for all or part of the necessary home health or hospice care services.

private third-party payers

Commercial Health Insurance - Most commercial health insurance policies cover some home health care services for immediate medical needs. However, coverage for long-term services varies. Sometimes commercial insurance companies will pay for professional home health care under a cost-sharing plan.

CHAMPUS (TRICARE Standard) - CHAMPUS, which stands for the Civilian Health and Medical Program of the Uniformed Services, covers certain home health care and hospice care services in a cost-sharing plan to dependents of active military personnel and military retirees.

Workers' Compensation - If a patient requires medical home health care services due to an injury sustained at work, he/she may be eligible for coverage under a workers' compensation plan.

Managed Care Organizations - Managed care organizations are group health plans. Coverage may include home health and hospice care services. Those managed care organizations contracting with Medicare must provide the full range of Medicare-covered home health and hospice services that are available.

This page was last updated on: February 15, 2008.

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