As costs continue to rise, the ability to pay for health care remains a source of concern for many American seniors. There are numerous options and programs out there to help seniors, families, and caregivers pay for care — so many, in fact, that knowing what is covered and by whom can feel overwhelming.
One such question is who pays for services in the home. In order to better understand the options for payment and coverage, it’s important to clarify the difference between home health care and other in-home services. The following overview outlines the two major categories of in-home care, and reviews the available avenues of payment. Yet we can hardly scratch the surface here, and each situation is unique — all the more reason to turn to an expert, like a medical social worker, to find the best resources to craft a total picture of coverage for your specific needs.
Understanding In-Home Care
The term ‘in-home care’ encompasses different types and levels of service, depending on the individual’s needs. Some seniors, for example, might need general assistance to help them continue to age in place, whether that takes the form of bathing or meal assistance, or other on-site aid to provide companionship or ensure safety. When care is not necessarily specific to a disease diagnosis and is not ordered by a doctor, it is called private duty care.
Unlike private duty care, home health care is provided by a skilled medical professional for a homebound patient. Home health care services are prescribed by a physician, and are therefore generally limited to medically focused visits: clinicians such as nurses and physical therapists help patients during a recovery period or with self-management of a specific chronic illness.
Private duty care and home health care are valuable and necessary in their own ways. It’s important to understand the difference, because the services offered and payment options vary. One big difference between these two types of in-home care is that private duty care is typically paid for out of pocket, whereas home health care is often fully or mostly covered, with no expense to patients.
Home Health Care Payment Coverage
As with any form of health care, the price of home health care can escalate quickly. Fortunately, numerous resources are in place that can help defray or eliminate these costs.
Federal programs: Some or all home health care services may be covered by Medicare, Medicaid, and/or VA benefits. Although qualifications must be met, home health services ordered by a physician as part of a specific plan of care are typically covered 100% by Medicare. What’s more, these programs can work together; for example, the Program of All-inclusive Care for the Elderly (PACE) is designed to cover patients under a combination of Medicare and Medicaid benefits. The experts at Residential Home Health are equipped to help confirm a patient’s eligibility for federal benefits.
Private health insurance: If you carry private health insurance, some or all home health care may be covered; if not, you may be able to find a new plan that will cover this care. Consider carrying multiple plans, as this may better cover costs, pairing options such as employer-provided insurance with another policy specially tailored to retirees or home health care. Note that with private insurance, co-pays may apply, and you may have to reach a deductible amount before the benefit begins. However, for home health care services that may not be covered by a federal plan, private insurance can help to further reduce out-of-pocket costs.
Personal assets: It can be daunting to reach into savings to pay for care, especially for the long term. But it may be possible that pressing health and financial needs could make this a necessary step. However, there are options to make the most of your total assets that can be better for long-term financial well-being as well as physical health.
- Set up a trust or purchase long-term care insurance.
- Use a reverse mortgage or other form of annuity, in which you can receive regular payments based on the equity in your home or on a single upfront investment.
- If you have a life insurance policy, you can convert this into income, or borrow money against the policy.
As with any financial decision, doing careful research and seeking advice from an expert are recommended.
Local resources: Look for public programs at the state and local level, as well as community resources that stem from places like churches and nonprofit organizations. Availability and benefits vary; it will likely require some legwork to figure out where they are and how they work.
Private Duty Care Expenses
Unfortunately, the costs of private duty care are not included in Medicare coverage, and such a benefit is rare in private insurance policies as well. Most individuals seeking private duty care for themselves or for a loved one should expect to pay for service. One alternative to paying entirely out of pocket, however, is to purchase long-term care insurance that covers private duty care.
Finding Your Best Solution
In order to minimize out-of-pocket expenses for in-home care, look to combine as many resources as there are available to you. Combine federal and state programs, or public and private options. For example, if Medicare covers the bulk of your home health care, you can investigate whether private insurance covers all or a portion of the remaining services.
It can also help to ask for more information. Any program you turn to will likely have resources to find additional assistance. Your friends and family may know of local resources to take advantage of.
Finally, seeking help from a professional who is in the know could be your best resource of all. In order to obtain benefits to which you’re entitled, you need to know what you should ask for, which you can’t do without knowing what is available to you. In this regard, seeking help from a qualified professional (such as a medical social worker) can pay for itself in terms of opportunities and resources uncovered.
Residential Home Health celebrates Social Work Month 2015 by recognizing the role of the Medical Social Worker as part of our complete picture of available home care services. To determine whether you or your loved one might benefit from our care, call (888) 930-WELL (9355) to discuss your specific situation with a Home Care Specialist today, or click here to take our Home Care Assessment.