Who Pays?

There are several payment options available for families and individuals seeking AdvisaCare services. Please explore the following common methods:

Medicare: 

Medicare is a federal program that covers the majority of home health visits and is available to individuals aged 65 and older, as well as those under 65 with qualifying disabilities who meet specific criteria. Qualifications include being homebound (with limited ability to leave home) and requiring intermittent skilled services like nursing or therapy visits for a defined period, typically around 60 days.

Medicare comprises two parts: Part A, which covers inpatient hospital and skilled nursing facility stays, and Part B, which covers doctor visits, prescription drugs, outpatient care, and hospice services.

Commercial Health Insurance: 

Commercial insurances are provided by private companies such as Blue Cross/Blue Shield, Humana, and United Health Care. These plans supplement Medicare and cover services under Part B. Coverage details and services vary depending on the insurance company and specific plan chosen.

Long Term Care Insurance: 

Long Term Care encompasses various medical, nursing, custodial, social, and community services designed to assist individuals with their daily activities. Long Term Care Insurance is private coverage designed to offer financial protection and support for necessary medical and personal care services due to chronic illnesses, disabilities, or injuries outside of a hospital setting, including private homes, assisted living communities, or skilled nursing facilities. Policy benefits can cover services like home health care, respite care, adult day care, and nursing home care.

Each policy is unique, with varying terms and benefits. Elimination periods determine the duration a policyholder must pay out of pocket before coverage begins. Functional incapacity requirements typically involve assistance with two or more daily activities. Maximum daily or weekly benefits, usually in increments of $100, depend on the chosen coverage option.

Private Pay: 

Private pay refers to individuals covering the cost of home health care themselves. This may include paying for services not covered by commercial insurance (out of pocket) or services not included in Medicare or private insurance benefits. These services encompass supportive care, such as bathing, dressing, meal preparation, light housekeeping, companionship, supervision, and medication reminders.

With no restrictions on the amount of care provided, individuals and home care agencies can mutually agree on services and associated costs.

These payment options offer flexibility and choices for individuals and families seeking various care plans and medical services for different health conditions and needs. Whether residing in assisted living facilities or seeking skilled nursing care, understanding these health benefits and payment methods can help in making informed decisions for care and managing health-related expenses.