Home health care refers to medical assistance provided in a patient’s own home by healthcare professionals such as physical therapists, occupational therapists and nurses. Services prescribed by a doctor often assist in activities of daily living like bathing, dressing and meal preparation – as well as transportation assistance, medication reminders or companionship depending on individual need. Medicare, Medicaid and Veteran’s benefits all offer coverage of some sort for home health care for seniors.
Private health insurance policies may provide coverage for some aspects of home healthcare, although typically only short-term skilled care and limited visits per week. Prior approval from your physician will typically be needed before hiring a home health aide is authorized under private policies.
Medicare alone may not cover home health care needs for some seniors with low incomes; state programs like the Medicaid Home and Community Based Services waivers offer home health services for those earning below 133% of the federal poverty line.
Home health care coverage varies significantly among commercial Blue Cross Blue Shield plans; some may cover all or some of a senior’s expenses while others require copays and/or deductibles be paid upfront before coverage kicks in. To determine your specific coverage, refer to your plan documents or reach out directly to your insurer.
If you or a loved one require home health care, it’s essential that they discuss all available options with family and healthcare providers. A physician can recommend an ideal course of action and assist in gathering any required paperwork or authorizations; home health agencies often can also help patients understand any out-of-pocket costs before beginning treatment.
If your insurance company denies a home health care claim, it’s essential that you know how to file an appeal. Working with an experienced health advocate or legal professional will be invaluable when taking this route. Alternately, you and/or your loved one can reach out directly to the home health agency to find alternative payment solutions. Home health agencies should always be upfront and honest when disclosing any items or services they cannot provide to ensure you have an accurate understanding of any out-of-pocket expenses you’ll be incurring. If an acceptable solution can’t be reached, additional funding sources such as individual retirement accounts (IRAs), health savings accounts (HSAs), pensions, investments and other assets could provide potential solutions.