Questions About Home Care

Questions about Home Care

Who is eligible for home care services?

Anyone can receive home care services.

How is care paid for?

Payment for home care services may be from a variety of sources based on the patient need and health status.

MEDICARE (T-18) – To receive coverage from Medicare patients must have Medicare or a Medicare HMO. Traditional Medicare Part A offers 100% coverage for the home health services at this time. Medicare HMOs may vary based on the plan specifications.

MEDICAID (T-19) – To receive coverage from Medicaid patients must have active Medicaid which requires that they meet income and asset requirements.

Commercial Insurance – Most employed individuals have insurance through their employers. Commercial insurance usually has some home care coverage though it will vary from policy to policy. Agency staff will be able verify your coverage for you.

Long-term Care Insurance – Long-term care insurance will cover the additional care that exceeds what Medicare or Commercial insurances allow. This type of insurance varies by policy and needs to be reviewed specific to each situation.

What are the qualifying conditions for home care?

Most patients seek home care following a hospitalization or an incident that requires some intervention. Payors to not require a specific clinical event, just an identified need for care for the services to be covered. Remember, anyone can receive home care, but it will only be paid for if your insurance company covers the services you need.

What is meant by “homebound”?

Medicare defines homebound as the inability to leave your home without considerable and taxing effort. Medicare and many insurances require a patient to be homebound to qualify for payment of home care services

What are the limits to the provision of services?

There are no limits to the care available in the home though there are limits to care that will be paid for by insurances. Medicare will cover nursing and therapy visits as long as they are needed under most circumstances. The only time that Medicare will cover daily visits is for a short period of time or if a patient requires daily insulin injections.

Aide care for personal care is covered by Medicare and most insurances.

It is important to know that insurances often follow Medicare regulations. When care is not covered for payment it can be purchased.

What if the patient requires care before the next scheduled visit?

The Agency has nurses on call around the clock to answer questions and make a visit when needed.

For Questions about Our Service or To Make a Referral, Please Call 414-365-8300 or Fax: 414-365-8330