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Questions about Home Health Care
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| Who covers home care services? |
Medicare, Medicaid, Private Insurance and private pay sources cover, or partially cover, home care services. Eligibility and coverage for home health care services differs for each insurer and many have different plans and benefits for different groups. Sometimes a home care agency can negotiate for services not ordinarily covered in certain plans. Some long term care insurance policies may include some home health as well as nursing home coverage. For patients who do not have insurance or whose insurance does not cover or only partially covers, many agencies have a sliding fee scale. |
| What is the Medicare Home Health Benefit? |
| The current Medicare program offers a home health benefit to individuals 65 and older and to disabled adults. Medicare will pay for home health services to Medicare enrollees only if all four of the following criteria are met: 1) The patient requires intermittent, skilled nursing care, physical or speech therapy. Care can be provided on a non-daily basis for as long as the care is skilled in nature, reasonable and necessary; 2) the patient is homebound. A patient is considered homebound if he or she has reasonable difficulty leaving the home unattended and leaves home infrequently for reasons other than medical. A patient can go to physician appointments or other similar activities and still be considered homebound; 3) the patient is under the care of a physician who determines the patient needs home health care; and 4) the Home Health Agency providing the services is a Medicare certified agency. Home health services covered by Medicare are skilled nursing care, physical therapy, occupational therapy, speech therapy, certified nurses aides, medical social services and durable medical equipment. Home health services NOT covered by Medicare include 24-hour a day nursing care at home, drugs and biologicals, homemaker services, blood transfusions and long term nonskilled nursing services. |
| What is the Medicaid Home Health Benefit? |
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The New Hampshire Medicaid Program helps pay health costs for all persons who receive public assistance and for certain persons with low incomes who can't afford the cost of health care. Once patients are accepted by the Medicaid |
| What is Managed Care? |
The main emphasis of managed care is to control utilization of services to achieve appropriate, efficient use of resources along with positive outcomes. As a result, managed care organizations employ such strategies as pre-authorization, re-authorization and ongoing case review. Benefit packages for home care services vary from company to company and from plan to plan with the same company. To be eligible f for home care services, patients do not necessarily have to be homebound. However, most managed care programs place an emphasis on getting the patient to the point where they can receive care in an outpatient or physician office setting. The actual home health coverage authorized for a patient is likely to be based on the initial assessment done by the Home Health Agency. Based on that assessment, the case manager will determine the extent and frequency of the home health services that can be provided. |
program, they are assigned a case worker who oversees and coordinates their care. Some people are covered by both Medicare and Medicaid. Medicaid pays Medicare deductibles and coinsurance. Medicaid may limit the number of payments for certain services. |
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