Who Pays for Services?

The cost of home care services can be paid out-of-pocket by clients and their families or covered by various public and private sources.

Medicare

Medicare — the federal health care program for nearly all Americans over 65, as well as thousands of younger people with disabilities — pays for home care in medically related circumstances. To qualify, a Medicare beneficiary must be confined to home; under the care of a doctor who certifies the need for care; and in need of skilled nursing care from a nurse, physical therapist, or speech therapist.

In addition, care must be provided by a Medicare-certified agency. Be aware, however, that Medicare doesn’t cover a lot of home care services, including most services provided by non-professional caregivers. If a client requires long term assistance, Medicare probably won’t cover it.

For more information on Medicare coverage, visit the Medicare coverage website.

Medicaid

Medicaid is a health care program that is jointly sponsored by the federal and state governments and administered at the state level. To qualify, a family or individual must have a low household income, with specific income limits varying from state to state.

Under Medicaid, states are required to provide home health benefits that include skilled nursing, home care aide services, and medical equipment and supplies. Some states provide these services in long term situations; others provide home care only for limited periods of rehabilitation.

To find out more about the Medicaid program in your state, contact your local public assistance office.

Private health insurance

Health insurance policies typically provide coverage for home care services but, as with Medicare, tend to cover only skilled care for limited periods. Many long-term care insurance policies cover home care as well as care in a nursing home. These plans are designed to provide care over much longer periods and generally cover the services of non-professional caregivers.

Consumers interested in purchasing long-term care insurance should be aware that home care benefits vary widely among plans. Close attention should be paid to limits on coverage and types of services covered.