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Home Health Care (Sources of Payment)

Sources of Payment for Home Health Services

Home health services can be paid for through a variety of public and private entities or by the patient and/or his family. Hospice benefits are most often provided without regard to the patient's and/or families ability to pay. The following listing shows all of the possible payor sources. A brief description of each area will follow.

Self-pay

    Home health services can be purchased privately by a patient using his or her own funds. Home health services which do not meet the criteria of a third-party payor must be paid for out of pocketby the patient or family. The patient and the home care provider can negotiate these fees.

Public Third-Party Payors

    Medicare —
    Home Health Services will be paid for by Medicare if your doctor certifies you meet the following criteria:

  1. You are homebound — confined to home except for infrequent or short absences or trips for medical care, and
  2. You require one or more of the following services: physical therapy, speech-language pathology, or skilled nursing.

If you require only personal or non-skilled care, you will not qualify for the Medicare home health benefit. The services you receive from a Medicare-certified home health provider must be intermittent or part-time and your doctor must periodically review your plan of care. For more general information about Medicare check out the Elder Care Network's legal page.

Medicaid —
A joint federal-state medical assistance program for low-income individuals. If you have Medicaid, you may be eligible for both skilled and non-skilled services. To find out more about Medicaid home health benefits, phone Larimer County Human Services, 498-6800. The Elder Care Network's legal page has more detailed information on Medicaid and long term care.

Older American's Act (OOA) —
Federal funds for state and local social service programs enable frail and disabled older persons to remain independent. This program provides services for those sixty years and older who have the greatest financial and social need. Contact Larimer County Human Services, 498-6800, for more information.

Veterans Administration (VA) —
A doctor must authorize these services to those Veterans who are at least 50% disabled because of a service-related condition. The services must be provided through the VA's network of hospital-based home health providers.

Social Services Block Grants —
Portions of federal social services block grants are directed to state-identified service needs. Contact Larimer County Human Services, 498-6800 or the Colorado Department of Health Care Policy and Finance, (303) 866-3864 for more information.

Community Organizations —
Depending on your ability to pay, some organizations in our community , along with state and local governments, provide monies for home health and supportive care. For a list of community organizations offering home health scholarships contact The Office on Aging at Larimer County Human Services, 498-6800.

Private Third-Party Payors

    Health Insurance Companies —
    Benefits vary from plan to plan. Most plans generally pay for skilled home health services with a cost-sharing provision. Hospice benefits cover most services including nursing, social work, therapies, personal care, medications and medical supplies and equipment. Cost-sharing varies, but is often not required for Hospice benefits. Be careful to ensure the provider you choose is one accepted by your insurance company. Many are contracting with certain providers to be the home health services provider for their plan. Most providers will work with you before services start to ensure payment by your insurance company.

    Medigap —
    Home health benefits under these plans are designed to cover services required when recovering from an acute illness, injuries or surgery. Some Medigap policies offer at-home benefits which pay for personal care services you need while receiving Medicare-covered skilled home health services. Most providers will work with you before services start to ensure payment by your insurance company. The Elder Care Network's legal page has more general information about medicare supplemental policies and Medicare managed care policies.

    Long-Term Care Insurance —
    Home health benefits vary greatly from plan to plan. Care should be taken in choosing a policy . Some have limitations on coverage, i.e., requiring prior hospital stays and excluding some pre-existing conditions. Most providers will work with you before services start to ensure payment by your insurance company.

    CHAMPUS —
    The Civilian Health and Medical Program of the Uniformed Services covers skilled nursing care and professional medical home care for dependents of active military personnel and military retirees and their dependents and survivors. CHAMPUS is contracting with certain providers to be the home health service provider for their beneficiaries. Most providers will work with you before services start to ensure payment by your insurance company.

    Workers' Compensation —
    An injury on the job, resulting in the need for medically necessary home health services, will be paid for through workers' compensation.

 

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