Medicare pays for the majority of home health visits and covers those 65+ and people younger than 65 with a qualifying disability and who meet the qualifications of the benefit. These include homebound status (can only leave home with great difficulty) and requiring intermittent skilled services such as nursing or therapy visits for a specific period of time (typically 60 days).
It is a federal program with two parts. Part A covers inpatient hospital and skilled nursing facility stays whereas part B covers visits to the doctor, prescription drugs, outpatient care and hospice services.
Commercial Insurances are private insurance companies such as Blue Cross/Blue Shield, Humana, and United Health Care that are supplemental to Medicare and cover the services under Part B. The types of services and coverage vary according to what company you use and what plan you pick.
Long Term Care refers to a combination of medical, nursing, custodial, social and community services designed to assist individuals with their activities of daily living. Long Term Care Insurance is private insurance which was designed to provide financial protection and coverage for necessary medical and/or personal care services due to a chronic illness, disability, or injury outside of a hospital setting such as the individual’s private home, assisted living community or skilled nursing facility. The policy benefits assist in paying for long term care services such as home health care, respite care, adult day care, and nursing home care.
Every policy is individually created so the terms and benefits vary. Elimination periods refer to the length of time the policy holder must pay out of pocket before the benefits are covered. The policy holder must meet functional incapacity requirements which is typically assistance with two or more activities of daily living. Maximum daily or weekly benefits, usually in increments of $100, will depend upon what coverage option the policy holder chose.
This type of payment means a person is paying for home health care themselves (private pay), paying the difference from what their commercial insurance does not cover (out of pocket), and the services which are not part of the Medicare and Private Insurance benefit. These include supportive care such as bathing, dressing, meal preparation, light housekeeping, companionship, supervision and medication reminders.
Since there are no limitations on the amount of care provided, the individual and the home care agency can mutually agree upon the services and the cost of care.