Most Americans older than 65 are eligible for home care services through the federal Medicare program. If an individual is homebound, meaning he/she cannot leave the home without physical assistance, is under a physician's care, and requires medically necessary nursing or therapy services, he or she may be eligible for services provided by a Medicare-certified home health agency.
Depending on the patient's condition, Medicare may pay for intermittent skilled nursing; physical, occupational and speech therapies; medical equipment may also be paid for. The referring physician must authorize and periodically review the patient's plan of care. With the exception of hospice care, the services the patient receives must be part time and provided by a Medicare-certified home health agency for reimbursement. This means a nurse, therapist or home health aide comes to the patient's home for brief periods. Medicare does not cover care in the home for shift-type care - only specific tasks performed by a nurse, therapist or home health aide.
Medicaid is a joint federal-state health care program for low-income individuals. Illinois' Medicaid program, administered through the Department of Healthcare and Family Services, pays for home care and has other programs for in home supports if people meet eligibility requirements.
3. Private Insurance HUMANA, BCBS, ATENA,
Commercial health insurance policies typically cover some home care services for when a person is recovering from surgery or illness. But benefits for long-term services vary from plan to plan. Commercial insurers, including Blue Cross and Blue Shield and others, generally pay for medical care in the home with a cost-sharing provision. Such policies occasionally cover personal care services such as help with meal preparation and light housekeeping. Most commercial and private insurance plans will cover comprehensive hospice services, including nursing, social work, therapies, personal care, medications, and medical supplies and equipment. Cost sharing varies with individual policies, but sometimes it is not required.
4. Long-Term Care Insurance
As the public's need and preference for home care has grown, private long term care insurance policies have expanded their coverage for in-home care as well as nursing home care. Home care benefits vary greatly among plans but most plans today cover home care.
5. Self Pay Insurance
People can arrange to pay for homecare services themselves if they desire. Homecare providers coordinate arrangements and billing. Rates and services available vary by provider.
6. Waivered Programs
These are programs for the elderly, children, developmentally disabled or disabled and handicapped adults. The Illinois Department on Aging and the Illinois Department of Human Services administer Medicaid wavered programs for those who meet certain eligibility requirements related to their physical and financial needs. Waivers may not claim the parental or spousal income in order to provide the services for an individual client. Authorization for this service is made by conducting an appropriate assessment. For information on services contact the Illinois Department on Aging at 1-800-252-8966 or the Illinois Department of Human Services at 1-800-843-6154.
7. Worker's Compensation
Following an injury or accident, home care services may be ordered for rehabilitation and recovery. Each insurance company has information on the policy coverage. Services provided vary upon the policy and nature of injury or illness.
8. Veteran's Benefits
A veteran may be eligible for home care services through authorization of skilled and custodial services. Often the order for home care services is made through a Veteran's hospital or clinic.