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Does Private Insurance Cover Home Health Care?

Many older adults desire to remain living at home as they age, yet may need assistance to do so safely. Some may require skilled home health care for medical needs while others simply require help with daily activities like bathing and getting dressed.

Most private health insurance plans do offer home health care coverage, yet each plan varies in terms of what services it covers and to what degree. Some plans might only offer specific home healthcare services like physical or occupational therapy while others will cover a more comprehensive suite of homecare services like nursing care or social support.

Home health care benefits can typically be obtained through private health insurance and Medicare plans as well as various state and local programs. Each of these has specific eligibility criteria and regulations that must be fulfilled; thus it’s up to you to inquire as to whether your loved one qualifies for these benefits.

Medicare typically covers home healthcare services when they’re part of a plan created and reviewed by a physician or practitioner (such as nurse practitioners, clinical nurse specialists or physician assistants). Home healthcare agencies must also give you an advance beneficiary notice (ABN) detailing how much Medicare will pay and any items not covered.

Medicare only covers short-term in-home health care services; however, some private insurers will cover long-term home care as well. Furthermore, most states offer long-term home care assistance programs for senior citizens in need; most often these are run by county offices for the aging and are subject to state regulations regarding home healthcare regulations.

Private health insurance is often the most cost-effective means of covering home health care costs when family members do not fulfill eligibility requirements for public programs. Policies can be obtained from private employers, individual/family insurers or through state and federal marketplaces; each of these providers are highly regulated with regards to which services they will cover and which they won’t.

Private pay options for home healthcare may also be an option, although they tend to be costly and don’t cover long-term care or personal assistance services. Most people who opt for this method either pay out-of-pocket or use long-term care insurance coverage.

New York Health Care can assist with various payment options, including private insurance. Our reimbursement specialist will work closely with you to make sure home health services are paid for on time – we look forward to serving you! To schedule home health services with us today, call our reimbursement specialist on 1800749-4762 or request a consultation online – our offices can be found throughout Brooklyn, Queens Manhattan and the Bronx and visit our FAQs page for additional details.