WHO PAYS FOR HOME HEALTH CARE AND HOSPICE?
Elixir Home Health Care and Hospice, Inc. accepts the following insurance plans to ensure that you achieve quality home health care and hospice services at home.
Majority of all home health visits are paid by Medicare. The Medicare program covers the elderly (those 65 and over).
Medicare is a federal program that has two parts – Part A and Part B. All home health services can be covered under either Part A or Part B while other forms of health care are only covered under one of the parts. For example, hospitals and short term nursing home care are covered only under Part A, while doctor’s visits, durable medical equipment, ambulance and outpatient services are covered under Part B.
Medicare is not an entitlement program, but rather an insurance program. As an insurance program, Medicare covers only certain situations and items that meet the program’s criteria.
To be eligible for home health service under the Medicare program, patient must meet at least the following:
- Have a valid Medicare card or other evidence showing entitlement to Medicare benefits.
- Require one or more of the primary services (nursing, physical therapy or speech therapy)
- Be under a physician’s plan of treatment that specifies Home Health Services.
Medicaid (Medi-Cal in California) is primarily a state program designed to provide necessary health care to low income citizens. Eligibility to receive services under the program is determined based on financial information, which is periodically reviewed. The focus of Medicaid is on both acute and long-term care needs of the eligible population.
To be eligible for home health services under the Medi-Cal program, a patient must have the following at a minimum:
- Have a valid Medicaid/Medi-Cal card covering the entire period when services are rendered.
- Be determined that the home is the most appropriate setting for homecare due to one of the following: medical hardship, contraindicated by the patient’s fragile and unstable condition, or interfere with effectiveness of the
- Require the services of a nurse, physical therapist, speech therapist, occupational therapist
Many commercial or private insurance companies, such as Anthem, Aetna, Cigna, Blue Cross/Blue Shield, and others, include home health benefits as part of their health insurance policies. The number of visits, types of services and requirements for coverage vary greatly. It is therefore necessary to check each commercial insurance policy for the particular patient and situation.
In general, many commercial insurance policies require a prior hospital stay, physician’s orders and need for intermittent skilled services to cover the cost of Home Health Services. Commercial insurance companies are increasingly offering case management programs that provide a variety of community-based services, including Home Health Services, as an alternative to more expensive institutional care.
Probably the least frequent payment source for home health care is self-pay in which home health agency reimbursement is made by the patient, family members, or other source of private income. This source is obviously the least restrictive in terms of eligibility requirements, since it is basically a contract between a client/family and the agency.
An agency’s own admission requirements will dictate the eligibility requirements and will probably include physician’s orders at a minimum.
Other Payor Sources
Many states have established special funding sources for home health care. Please contact 1st choice for your healthcare needs.
For more inquiries about our accepted insurance plans, do not hesitate to send us a message through our online form.