Your Question & Answer

Q: Will Medicare or my insurance policy cover these kinds of services?

A: Medicare covers home health care that is temporary and part-time, but only if you meet all the following requirements:

  • Your doctor must say that you need the care. And your doctor must document that you need care at home and make a plan for that care.
  • You must need skilled care or therapy (physical, speech or occupational).
  • You must be homebound. “Homebound” means that leaving home is a major effort and you cannot do it without help. When you do leave home, it must be to get medical care or for short, infrequent nonmedical reasons such as a trip to get a haircut, attend religious services or go to adult day care.
  • The home health agency must be Medicare-approved. For a list of approved agencies, visit www.medicare.gov or call 1-800-MEDICARE.

If you do meet the above requirements, Medicare may pay for these services on a limited basis if you are also receiving skilled care, such as nursing care or other therapy. However, Medicare does not pay for 24-hour a day home care, prescription drugs, meals delivered to your home, homemaker services (such as housekeeping, laundry and shopping) or on-going personal care.

When it comes to insurance coverage, all policies are different. Some companies provide allowances for home health care, but it is usually limited. If you are uncertain as to whether your insurance company provides coverage or reimbursement for these services, you should contact your local insurance representative directly for answers.

When seeking financial assistance for these services, please note that Health Horizons has preferred relationships with many companies who either fully reimburse or partially reimburse for home health care. Typical accounts for reimbursement include reverse mortgage, health savings accounts (HSAs) and flexible spending accounts. We also work with reimbursement programs like the Veterans Aid and Attendance Benefit, which is a benefit paid in addition to the monthly pension paid to Veterans and surviving spouses who require our services.

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