Home Care or Home Health Care is eligible for Medical and / Medicaid payment in many situations. Private Insurance payments are also widely used. Depending on the coverage conditions, out of pocket payments may have to be made by the clients who receive services.
When services are covered by Medicare and/or Medicaid, home care providers must bill their fees directly to the payor to Medicare or Medicaid. Providers often will bill other third-party payors directly as well. Any uncovered costs are later billed to the client. However, if a client receives services from a registry or independent provider, he or she must pay the provider directly. Later the client may file for reimbursement from the insurance company if the services qualify as covered benefits.
The following are the payment scenarios depending on the service provider. As you will notice, the payment situation varies with each individual case.
Home Health Agencies
Medicare, Medicaid, and most private insurance plans pay for services that home health agencies deliver. Payment from these sources depends on whether the care is medically necessary and the individual meets specific coverage criteria. Individuals may opt to pay out of pocket for services that are not covered by other sources.
Some agencies receive special funding from state and local governments and community organizations to cover the costs of needed care when other options are not available.
Homemaker and Home Care Aide Agencies
Individual consumers usually pay for services from homemaker and HCA agencies. However, some states contract with these agencies to deliver personal care and homemaker services within their social services and medical assistance programs. On rare occasions, commercial insurers may pay for a portion or all of the costs of these services. Some agencies draw assistance from charitable community funds when other sources of payment are not available.
Staffing and Private-duty Agencies
Typically, the individual or his or her commercial insurance carrier pays for services provided by staffing and private-duty agencies, provided that the insurance policy’s coverage requirements are met. Some staffing agencies contract with state Medicaid programs to provide nursing and personal care services.
Coverage for hospice care is available through Medicare, Medicaid programs in 38 states, and most private insurance plans. If insurance coverage is insufficient or unavailable, the patient and his or her family may pay for services out of pocket. Most hospices may provide free services to individuals who have limited or no financial resources.
Pharmaceutical and Infusion Therapy Companies
Pharmaceutical and infusion therapy supplies and services are almost always paid for by commercial insurance companies and Medicaid. Medicare covers the cost of nutritional supplements and certain medications when the situation meets strict coverage criteria.
Durable Medical Equipment and Supply Dealers
Fees for durable medical equipment and supplies are usually covered by Medicare, Medicaid, and commercial insurance programs, provided that the products are ordered by a physician and are medically necessary to treat an illness or injury.
The individual client generally pays for registry services. In some cases, commercial insurance companies may reimburse a portion or all of these costs.
Usually the individual pays (private pay) for services rendered by independent providers. Some commercial insurance policies will provide reimbursement if the services qualify as covered benefits.