One of the most common questions we get is “does insurance cover home care.” Navigating the waters of home health care coverage can be a bit murky. Coverage depends on the home care services needed, length, care, and your insurance plan. There isn’t one definite answer to the insurance coverage question, but there are several options.
At Southern Comfort Home Care, standard private insurance does not cover our services. For most home care agencies, long term care insurance is accepted. There are also options with Medicare, Medicaid, and other coverage plans.
Our goal at Southern Comfort is for you or your loved one to receive the proper care needed to age comfortably at home. The financial side of home care shouldn’t be a burden for patients, or those considering our services. Below, we break down some coverage options so you can be sure you receive the home care services you are looking for.
Home Care Or Home Health Care? It Matters To Insurance Companies
Before knowing if your home health care is covered by insurance, it’s important to understand what is considered home health care. Home health care consists of medical based services like private nurses or therapy sessions. Since these services are often medically necessary, obtaining insurance coverage can be easier.
Home health care agencies can also provide home care services. These include private home health aides who help with caregiving services like bathing, eating, grooming, and more. Home care services are more companion-based and may not be medically necessary. Usually, these services are not covered by insurance.
Home health care and home care can share similarities, so it’s always important to know what services you’ll be needing. For all the coverage options below, it’s also important to have a clear understanding of your policy of what will be covered.
Understanding Your Home Health Care Coverage Options
While home health care is not covered under private insurance, seniors and their families have plenty of options.
Medicare & Medicaid
Medicare covers most home health care services like private nurses and speech therapy, physical therapy, and occupational therapy. There are requirements such as doctor referrals, being homebound, and only needing part-time care.
Caregiving services like bathing, dressing, and transportation are not essential and aren’t covered under Medicare. For any gaps that aren’t covered by Medicare, we’ll work with you and Medicare to get coverage.
For Medicaid, coverage varies by state, but services are usually covered. Both medical and companionship home care services can be covered to some degree. Home and Community Based Services Medicaid waivers are another option that expands coverage.
Long Term Care Insurance
Because most private insurance doesn’t cover home health care, many people choose to buy long term care insurance, if eligible. Long term care insurance covers most services including home care, nursing homes, and other assisted living facilities.
Long term care insurance can be very expensive and might only cover certain home care services. It’s important to understand your full policy to ensure the services you need will be covered.
When other insurance plans won’t cover exactly what you need for home health care, cashing out a life insurance plan is an option. Most life insurance policies allow you to take out loans or cash out the entire policy. Cashing out your policy can impact Medicaid eligibility, so it’s important to seek advisement.
Other life insurance options include converting it to a long-term care benefit plan. A third party buys the plan and pays the home care services. It is important to understand however, that under this option the third party ultimately receives the death benefits of the policyholder.
For those wanting home health care, but needing extra help, reverse mortgages are a cash option that doesn’t rely on an insurance company. Reverse mortgages are cash loans against the equity of your home.
Just like with insurance policies and other coverage options, there are pros and cons to reverse mortgages. The bank does not own your home, but the loan money must be paid back once the home is sold, or the owner moves out.
For seniors eligible for VA benefits, home care services are covered. An advantage of VA benefits is that these services include caregiver services rarely covered by insurance. Bathing, transportation, eating, and more are typically covered by VA benefits.
Planning for Home Health Care
When it comes to home health care coverage, there are several options. Some people pay out-of-pocket, others take out loans, and others find new insurance policies. Every payment option has its own advantages and disadvantages, and it’s important to understand your choices.
Financial advisors and attorneys who specialize in elder law are a great resource. When choosing an insurance policy, make sure it’s understood exactly what services are covered. When cashing out life insurance policies or taking out loans, make sure you know what happens after. It’s also important to understand your home health agency and any policies they have.
Explore Your Coverage Options With Southern Comfort Home Care
Planning for home health care can seem overwhelming, but there is an option out there that works best for you, or your loved one. Southern Comfort wants all seniors to receive the care they need to live comfortably in their homes.
Contact our team for more information about our home health services, coverage, and finding the best option.