Insurance Requirements for Home Health Care

Home health care is a term referring to medical services provided in the home. Services consist of nursing care, therapy, home maintenance and repair, transportation, and even companionship. Essentially, any service provided in the home that enables a person to live semi-independently, while recovering from an illness or surgery, is considered home health care.

Research conducted by the National Association of Home Health Care and the Virginia Foundation of Independent Colleges found that the general public is unfamiliar both about home health care services and about the eligibility requirements. If this applies to you, you have come to the right place.

Individual and Group Health Plans

• The home health care benefits of individual and group health plans vary considerably. The general rule is that most plans cover all or a portion of home health care costs when approved by a physician for acute care services, but most do not cover personal care services. It's best to contact your provider directly to review your plan's benefits.

Medicare

• Medicare covers physician-approved acute care services for seniors over age 65 who are homebound, under a doctor's care, and require medical care if services are provided by a Medicare-certified home health care agency. Medicare also may approve skilled nursing services, therapy, and medical equipment for seniors depending on their physician's prescribed care plan.

Medicaid

• Home health care benefits differ from state to state under Medicaid, but all states must provide seniors over 65 receiving federal income assistance home health care services. You will need to contact your state's Medicaid agency for benefit information.

Veterans

• The Veterans Administration offers acute home health care to veterans who are at least 50-percent disabled from a service-related injury. There is no age requirement. Services must be approved by a physician and must be delivered by the Veterans Administration health network. Personal services are not available.

Other Options

• States and community-based organizations receive federal funding, under the Older Americans Act, to deliver personal home health care to low-income individuals over the age of 60. The type and availability of services varies by provider. Individuals are asked to pay a small fee to cover a portion of the cost. Your Local Area Agency on Aging, a community organization serving seniors, can provide more information on the programs and providers available in your area. A link to the National Association of Area Agencies on Aging is: http://www.n4a.org.

  Of course, there are no age requirements, income limits or physician approvals needed to obtain home health care if you are willing to pay out-of-pocket. Since it's possible to negotiate your rate for services, self-pay may be a financially viable option.