Home care services may be covered by a variety of sources and programs. If the care is medically necessary and the client meets certain coverage requirements, Medicare, Medicaid and most private insurance plans will usually pay for home health care services. However, benefits and eligibility requirements vary so it’s important to understand the terms of your coverage.
For services that are not covered, you can pay on your own. If you are unable to pay, we can discuss a sliding fee schedule and free care options.
Hospice services are covered by Medicare and most private insurance and managed care plans.
Major sources of payment for home care services
Medicare: The individual must be under a physician’s plan of care, homebound, and in need of part time or intermittent skilled nursing care or occupational/physical/speech therapy. The agency providing the services must be a Medicare-certified agency. The range of covered services may include skilled nursing care, home heath aides, speech and occupational therapy, medical social services and medical supplies/equipment.
Medicaid: The New Hampshire Medicaid Program helps pay health care costs for all persons who receive public assistance and for certain persons with low incomes who can’t afford the cost of health care. It is based on federal and state rules and people must meet income and resource limits to qualify.
Private Health Insurance: Policy coverage differs greatly. Generally, private insurance coverage is limited to physician-directed medical services and equipment. Long term care insurance policies may include home health as well as nursing home coverage. Be sure to check with your insurance company first to determine coverage specifics.
Health Maintenance Organizations (HMOs): HMOs and Comprehensive Medical Plans (CMP) with Medicare contracts must provide the full range of Medicare-covered services that are available in a geographic area, including home health care services.
Private Pay: Home care services can be paid by the individual or their family based on the scope of services.
Workers’ Compensation: Any person needing home care services as a result of injury on the job is eligible. Workers’ compensation representatives have information on coverage.
CHAMPUS/VA Benefits: On a cost-shared basis, skilled nursing care and other professional medical home care services are covered for dependents of active military personnel, retirees and their dependents and survivors.