Does Health Insurance Cover In-home Care?
In-home care can consists of various situations, with the exact scenario and your specific health insurance policy dictating what is covered. Health insurance may pay for part of your in-home care needs, or it may not pay for any of them all.
Depending on your needs, there are also other types of insurance and options that may help you pay for the services you require. Your first order of business is to determine the type of in-home care needed.
What types of in-home care are there?
One type of in-home care is long-term care, which usually includes people of all ages who have ongoing illnesses or disabilities. Another type of home care lasts for a shorter and specified amount of time, usually meant to help people recover from injuries, surgeries, or other conditions that are typically neither chronic nor terminal.
How can I pay for long-term care?
Traditional health insurance policies do not usually pay for long-term care, according to the U.S. Department of Health & Human Services website, HealthCare.gov. One of your options includes obtaining a long-term care insurance plan designed specifically to cover a range of long-term care needs.
Long-term care can apply to care given at home, in a nursing home, or in another type of community facility, and the policies vary greatly. Some policies may be meant to specifically cover services only received in a nursing home, while others may offer coverage for assisted living only.
You would want to find a policy that specifically covered services required in your own home, plus any extras that could be helpful. Some policies may cover part of the expenses of medical equipment, for instance, which can help cut your costs down dramatically.
What about government options?
Long-term care insurance is offered by the government as part of its Federal Long-Term Care Insurance Program for people employed by the federal government or in the armed services. The option extends to current members, retired members, and qualified relatives of the member.
Medicaid may pay for some portion of long-term care services for individuals who meet the requirements. Like health insurance, Medicaid coverage and stipulations vary from state to state.
Veteran benefits may help pay for long-term care for veterans who suffered disabilities from their time in service and others who may be eligible. The Department of Veterans Affairs also offers various allowance programs for veterans and their spouses who need help at home with personal care or other services.
A program known as PACE, or the Program of All-Inclusive Care for the Elderly, may be another option. The program offers in-home care to those who need the same level of care offered in a nursing home but would rather stay in their own homes.
To qualify for PACE, participants must be 55 years old or above, live in an area where PACE offers services, and be certified by the state as requiring a care level comparable to a nursing home. You must also be able to live safely on your own at the time of enrollment.
One more option is the newly enacted CLASS, or Community Living Assistance Services and Supports program. The program was part of the Affordable Care Act and was expected to begin in October 2012.
This is a voluntary program for employed individuals over the age of 18 who can still live on their own but need help to remain independent. Eligible participants can receive support services and assistance. They may also be eligible for cash benefits after contributing to the fund for five years.
What are the most common services needed for long-term care?
In-home long-term care commonly includes three different categories where people need the most help, according to the My Senior Care website. These are in-home nursing and therapy, home health aides, and hospice care.
The nursing and therapy category includes the services of a licensed nurse and health-related therapists, provided they are prescribed by a doctor. Nurses can help with medications and monitoring while therapists can provide speech, respiratory, occupational, and other types of therapy.
Home health aides are the ones who help with bathing, feeding, and other personal care tasks. Hospice care is care provided anywhere for a terminally ill patient. This can include pain relief and other medications, support for family members, and social services related to terminal illnesses.
What about in-home care that is not necessarily long-term care?
Some health insurance policies may cover a portion of in-home care to help people recuperate from injuries, surgeries, or other short-term conditions. Each policy varies, but you may be able to receive at-home physical therapy or other services if you are unable to leave the house to attend sessions in an office.
The coverage for such services may be limited to around 60 days, which is definitely not a long-term solution to any ongoing issue. The services would also have to be deemed medically necessary for coverage to apply.