Family - Selecting a Home Care or Hospice Provider
Paying for Home Care
Home care and hospice services are paid for through many sources. If you are relying on government programs, it is unlikely that any one program will cover all your needs. It usually takes some combination of Medicare, Medicaid, private insurance or personal assets to maintain an individual at home.
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. Click here to learn more.
Medicare
Most Americans aged 65 or older are eligible for the federal Medicare program. Medicare requires that the following conditions be met before reimbursing for home health services:
Medicare covers hospice services for individuals who are terminally ill and have a life expectancy of six months or less. For hospice coverage, the patient need not be homebound or in need of skilled nursing care. A physician's certification is all that is required to qualify an individual for the Medicare Hospice Benefit. Perhaps the biggest barrier for Medicare beneficiaries receiving hospice care is making the decision to choose the Hospice Benefit over traditional Medicare and/ or obtaining the physician signature. Often, patients do not receive certification in a timely manner because of concern that their life expectancy may exceed six months. However, Medicare has been consistently clear that the six months is an estimation based on the physician’s opinion and exceeding the six months is not cause for penalty.
Medicare Part A beneficiaries currently do not have to pay any co-payment for covered home health or hospice services. However, beneficiaries of Medicare Advantage plans (Medicare Managed Care) may have a sizable co-pay.Medicare rules state that “a patient is free to choose any qualified institution, agency, or person offering him/her services.” Medicare Home Health is a short-term acute care service. It does not pay for Long Term Care.
Medicaid
Medicaid is a joint federal-state healthcare program for low-income individuals. The Indiana Medicaid program pays for home health care and hospice and has other programs for in-home supports if people meet clinical eligibility requirements. Individuals may refer for the Indiana Medicaid Member Page for information about the Medicaid program. To apply for Medicaid, contact the office local Division of Family Resources (DFR) office in your county. You may obtain that information by accessing the Family and Social Services Administration (FSSA), DFR Home Page for Medicaid Eligibility, Medicaid “Waiver” or LTCOptions: The LTCOptions program administered by the Family & Social Services Administration provides state-funded supportive services to elders and disabled individuals who meet income and functional eligibility guidelines. These non-medical supportive services are designed to enable frail elders to remain in their homes - wherever home my be.
Commercial Health Insurance
Commercial health insurance policies typically cover some short-term, or intermittent, home care services for when a person is recovering from surgery or illness. However, benefits for long-term services are very rare. Commercial insurers generally pay for medical care in the home with a cost-sharing provision. Most commercial and private insurance plans will cover comprehensive hospice services. Cost sharing varies with individual policies. You should contact your health insurer for more information.
Reverse Mortgages
For many of us, our home represents our largest asset. Reverse mortgages allow seniors who own their homes to access the equity to pay for long term care and other expenses. Reverse Mortgages are complicated financial products and you should seek qualified professional advice before committing to one.
Other
There are other sources of payment for home care services. These can include Workers Compensation, the Veterans Administration, the Military Health Program, the Older Americans Act and more.
Self Pay
People can arrange to pay for home care services themselves if they desire. Home care agencies coordinate arrangements and billing. Rates and services vary by provider.
Home care and hospice services are paid for through many sources. If you are relying on government programs, it is unlikely that any one program will cover all your needs. It usually takes some combination of Medicare, Medicaid, private insurance or personal assets to maintain an individual at home.
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. Click here to learn more.
Medicare
Most Americans aged 65 or older are eligible for the federal Medicare program. Medicare requires that the following conditions be met before reimbursing for home health services:
- A physician certifies the need for services and establishes a plan of care
- The beneficiary meets Medicare's definition of "homebound"
- The care is to be provided in the patient's place of residence
- The services are provided by a Medicare-certified home health agency
- The individual needs skilled nursing or physical or speech therapy on an intermittent basis
Medicare covers hospice services for individuals who are terminally ill and have a life expectancy of six months or less. For hospice coverage, the patient need not be homebound or in need of skilled nursing care. A physician's certification is all that is required to qualify an individual for the Medicare Hospice Benefit. Perhaps the biggest barrier for Medicare beneficiaries receiving hospice care is making the decision to choose the Hospice Benefit over traditional Medicare and/ or obtaining the physician signature. Often, patients do not receive certification in a timely manner because of concern that their life expectancy may exceed six months. However, Medicare has been consistently clear that the six months is an estimation based on the physician’s opinion and exceeding the six months is not cause for penalty.
Medicare Part A beneficiaries currently do not have to pay any co-payment for covered home health or hospice services. However, beneficiaries of Medicare Advantage plans (Medicare Managed Care) may have a sizable co-pay.Medicare rules state that “a patient is free to choose any qualified institution, agency, or person offering him/her services.” Medicare Home Health is a short-term acute care service. It does not pay for Long Term Care.
Medicaid
Medicaid is a joint federal-state healthcare program for low-income individuals. The Indiana Medicaid program pays for home health care and hospice and has other programs for in-home supports if people meet clinical eligibility requirements. Individuals may refer for the Indiana Medicaid Member Page for information about the Medicaid program. To apply for Medicaid, contact the office local Division of Family Resources (DFR) office in your county. You may obtain that information by accessing the Family and Social Services Administration (FSSA), DFR Home Page for Medicaid Eligibility, Medicaid “Waiver” or LTCOptions: The LTCOptions program administered by the Family & Social Services Administration provides state-funded supportive services to elders and disabled individuals who meet income and functional eligibility guidelines. These non-medical supportive services are designed to enable frail elders to remain in their homes - wherever home my be.
Commercial Health Insurance
Commercial health insurance policies typically cover some short-term, or intermittent, home care services for when a person is recovering from surgery or illness. However, benefits for long-term services are very rare. Commercial insurers generally pay for medical care in the home with a cost-sharing provision. Most commercial and private insurance plans will cover comprehensive hospice services. Cost sharing varies with individual policies. You should contact your health insurer for more information.
Reverse Mortgages
For many of us, our home represents our largest asset. Reverse mortgages allow seniors who own their homes to access the equity to pay for long term care and other expenses. Reverse Mortgages are complicated financial products and you should seek qualified professional advice before committing to one.
Other
There are other sources of payment for home care services. These can include Workers Compensation, the Veterans Administration, the Military Health Program, the Older Americans Act and more.
Self Pay
People can arrange to pay for home care services themselves if they desire. Home care agencies coordinate arrangements and billing. Rates and services vary by provider.