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How Is Home Health Care Billed?
Date Updated: December 9, 2024
Written by:
Sarah has produced thousands of articles in diverse niches over her decade-long career as a full-time freelance writer. This includes substantial content in the fields of senior care and health care. She has experience writing about wide-ranging topics, such as types of care, care costs, funding options, state Medicaid programs and senior resources.
Reviewed by:
Kristi Bickmann, a licensed Long-Term Care Specialist, represents top-rated "Traditional" & "Hybrid" LTC companies. Serving associations such as the American Nurses Association, she's a licensed insurance agent in 27 states. Specializing in insurance products for seniors, Kristi helps hundreds of families every year protect assets, retirement, and loved ones. She understands aging concerns firsthand, having assisted her own parents. Kristi ensures accuracy on topics about senior long-term care and its consequences.
Home health care is billed directly to the individual or organization responsible for paying for services. For many seniors, this means bills go directly to health insurance providers. However, those liable for self-funding their care must agree on payment terms with their home health care agency.
Medicare and Medicaid Home Health Care Coverage
Many older adults qualify for Medicare funding for doctor-ordered, medically essential home health care. Parts A and B cover different services, but terms for each commonly include using a CMS-approved provider. In this case, home health agencies bill Medicare directly for permitted services delivered according to customized care plans. Seniors may have copayments for supplemental services.
Home health care recipients may also qualify for Medicaid funding through traditional state plans or Home and Community-Based Services waiver programs. Medicaid-certified companies must deliver services, and they charge Medicaid directly.
Other Billing and Payment Methods
When veterans qualify for home health coverage through VA Health Care, the VA contracts with specific service providers and invoices them directly. Long-term care insurers and home health agencies typically arrange claim and reimbursement schedules on behalf of those eligible for coverage.
In some situations, seniors don’t qualify for public assistance or insurance coverage. They must arrange to pay their care fees from private resources, such as income and savings. When this happens, they must understand the payment terms specified in their service contracts. Some agencies require advance payments, while others accept payments in arrears. Billing cycles vary among companies, meaning some may send daily, weekly or monthly demands.