Payment for home care can come from many sources. Depending on your age, diagnosis or financial status, Medicare or Medicaid may pay for your care in the home. Persons who are under age 60 and have severe disabilities may qualify for the Illinois Department of Human Services' Home Services Program. Persons age 60 or older may qualify for such programs as the Illinois Department on Aging's Community Care Program or other programs listed below. Also, private insurance offers coverage of homecare services and of course, you can pay yourself for care in the home.
Home health agency staff help you verify coverage before services are provided. Most home care agencies take care of all paperwork and billing.
Most Americans older than 65 are eligible for home care services through the federal Medicare program. If an individual is homebound, meaning he/she cannot leave the home without physical assistance, is under a physician's care, and requires medically necessary nursing or therapy services, he or she may be eligible for services provided by a Medicare-certified home health agency.
Depending on the patient's condition, Medicare may pay for intermittent skilled nursing; physical, occupational and speech therapies; medical equipment may also be paid for. The referring physician must authorize and periodically review the patient's plan of care. With the exception of hospice care, the services the patient receives must be part time and provided by a Medicare-certified home health agency for reimbursement. This means a nurse, therapist or home health aide comes to the patient's home for brief periods. Medicare does not cover care in the home for shift-type care - only specific tasks performed by a nurse, therapist or home health aide.
Hospice services are available to individuals who are terminally ill and have a life expectancy of six months or less; there is no requirement for the patient to be homebound or in need of skilled nursing care. A physician's certification is required to qualify an individual for the Medicare Hospice Benefit. Hospice is covered by most insurance plans, including Medicare and Medicaid, with few out-of-pocket costs to the patient. The Medicare hospice benefit covers costs related to the terminal illness, including the services of the hospice team, medical equipment and supplies
Medicaid is a joint federal-state health care program for low-income individuals. Illinois' Medicaid program, administered through the Department of Healthcare and Family Services, pays for home care and has other programs for in home supports if people meet eligibility requirements.
Commercial health insurance policies typically cover some home care services for when a person is recovering from surgery or illness. But benefits for long-term services vary from plan to plan. Commercial insurers, including Blue Cross and Blue Shield and others, generally pay for medical care in the home with a cost-sharing provision. Such policies occasionally cover personal care services such as help with meal preparation and light housekeeping. Most commercial and private insurance plans will cover comprehensive hospice services, including nursing, social work, therapies, personal care, medications, and medical supplies and equipment. Cost sharing varies with individual policies, but sometimes it is not required.
As the public's need and preference for home care has grown, private long term care insurance policies have expanded their coverage for in-home care as well as nursing home care. Home care benefits vary greatly among plans but most plans today cover home care.
People can arrange to pay for homecare services themselves if they desire. Homecare providers coordinate arrangements and billing. Rates and services available vary by provider.
These are programs for the elderly, children, developmentally disabled or disabled and handicapped adults. The Illinois Department on Aging and the Illinois Department of Human Services administer Medicaid wavered programs for those who meet certain eligibility requirements related to their physical and financial needs. Waivers may not claim the parental or spousal income in order to provide the services for an individual client. Authorization for this service is made by conducting an appropriate assessment. For information on services contact the Illinois Department on Aging at 1-800-252-8966 or the Illinois Department of Human Services at 1-800-843-6154.
Following an injury or accident, home care services may be ordered for rehabilitation and recovery. Each insurance company has information on the policy coverage. Services provided vary upon the policy and nature of injury or illness.
A veteran may be eligible for home care services through authorization of skilled and custodial services. Often the order for home care services is made through a Veteran's hospital or clinic.
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