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How can I afford home healthcare services?

Home healthcare services can be costly. Some services may be partially covered by private medical and disability insurance policies. However, home health care on a long-term basis may have to be financed through personal funds and state and federal medical assistance programs.

If your insurance policy or a government program will not normally cover those needs, your doctor or a home healthcare company may be able to negotiate for you with the insurance carrier. Specifically, if it can be shown that it is less expensive to deliver the needed services to you at home rather than in a hospital, they might consider covering costs for a time.

Medicaid is a government assistance program for people who meet certain low income requirements. It is jointly funded by the federal and state governments and operates under national and individual state guidelines. Eligibility for Medicaid varies from state to state. Some states have "medically needy" options to cover the cost of medical care for persons who would qualify for Medicaid on the basis of the services they require, but have too much income to qualify for the program and too little to pay for the needed medical services.

Medicare is a national health insurance program that pays for acute medical care services for people age 65 or older or those who have qualified for government disability benefits.

In most cases you need to meet all of the following conditions to be eligible for insurance or Medicare-covered home healthcare benefits:
  • Your doctor must determine that you need medical care, and write a prescription referring you to home healthcare services.
  • You must need at least one of the following care services: intermittent skilled nursing care or physical therapy, speech-language therapy, or ongoing occupational therapy.
  • You may need to choose a home health agency that is certified or approved by the insurance company or assistance program. For example, the agency may need to be Medicare-certified.
  • You must meet certain requirements such as not being able to leave home unassisted or being confined to home by illness. Leaving home for medical treatment, adult day services or short, infrequent trips is allowed.
Private insurance may cover some home healthcare services. Check your policy to find out if your home healthcare needs will be covered. If so, find out the length of time services will be covered.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.