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Home Health Care Explained: What It Is, What to Expect, How to Pay For it & How to Find It

By Gilbert Guide
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What It Is

Home health care agencies provide in-home skilled nursing and other home health care services, such as physical and occupational therapy. Home health care agencies are licensed by the state, but must adhere to federal regulations as well.

What to Expect

Home health must be prescribed by a physician. Registered Nurses (RNs), Licensed Practical Nurses (LPNs) and Licensed Vocational Nurses (LVNs) provide the care, sometimes in conjunction with other health professionals. These providers may also enlist the assistance of a home health aide who can help with personal care such as bathing and using the toilet. Home health aides can also administer medication under the supervision of a nurse.

Paying for Home Health Care

Medicare is the principal provider of home health care in the U.S. and covers a substantial part of home health care. Home health care is also covered by Medigap policies D, G, I and J, and Minnesota State's Extended Basic Plan policies, Medicaid, Managed Care and Veterans Benefits. Home health care is doctor prescribed. For a detailed description of all types of reimbursements, click here.

Medicare

What It Covers

  • Part-time or intermittent nursing care provided by or under the supervision of an RN; up to 35 hours per week combined skilled nursing and home health aide services
  • Physical, occupational and speech therapies
  • Medical social services as directed by a doctor
  • Home health aides providing personal care services (must be administered at the same time as skilled services)
  • Prescribed medical supplies
  • Durable medical equipment, such as wheelchairs, hospital beds and oxygen pumps (covered at 80 % of the Medicare-approved amount)

Conditions and Limitations

  • Doctor must determine need for home health care and prescribe care plan
  • Beneficiary must be homebound
  • Beneficiary must require intermittent skilled nursing care, or physical, occupational or speech therapies
  • Services must be received from a Medicare-certified home health agency

Medigap

What It Covers

Medigap policies D, G, I and J, and Minnesota State's Extended Basic Plan have a benefit that covers home health and in-home care. The coverage varies according to the policy you choose. The benefits may include assistance with activities of daily living such as bathing, grooming, medication monitoring, meal preparation, light housekeeping, laundry, errands, grocery shopping and transportation.

Conditions and Limitations
In order to be eligible for these benefits, the individual must currently be receiving Medicare-covered skilled home health care.

Managed Care

What It Covers

Utilizing its own network of doctors, hospitals and services, Managed Care policies cover everything that Medicare covers (see Medicare), in terms of home health care. You must get authorization from the insurance company before receiving services.

Medicaid

What It Covers

Medicaid pays for most skilled nursing services at home, including medical equipment that a doctor deems necessary, as long as it is less expensive than living in a skilled nursing facility. Some states do offer waivers—if an individual can prove a need for home health care and that it will be cheaper than skilled nursing in a facility.

Veterans Benefits

What It Covers

Home health care is provided by the VA or through contract agencies to veterans with chronic conditions. The services include skilled nursing, physical and occupational therapies and social services.

Conditions and Limitations

  • Veteran must meet eligibility criteria for VA benefits
  • Be homebound
  • Demonstrate need for home health care

Finding and Assessing Home Health Care

Prescriptions for home health care usually are accompanied by a recommendation for where to find it as physicians usually have established relationships with home health care providers. Gilbert Guide provides information on how to assess home health care agencies so you can find the caregivers who will best meet your needs along with national home health care agency listings. Gilbert Guide also offers a detailed explanation of Medicare's home health care quality measures.