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Breaking News
Choosing a Medicare Managed Care Plan
The PA Health Care Cost Containment Council and the PA Department of Aging are offering a guide to provide consumers with information about Medicare managed care options. The booklet, "Choosing a Medicare Managed Care Plan" is availabe in regional versions (Central, Western and Southeastern) and contains comparisons of the out-of-pocket expenses that beneficiaries will incur, and benefits offered by each of the different managed care plans.
New for this year's guide is information to help people learn more about the prescription drug card options. The report also includes measures that will help consumers compare the quality of plans such as members' satisfaction with each plan and several disease management options.
These booklets would be excellent resources to agencies' consumers. If your agency is interested in receiving copies, PHA has secured several copies or you can contact the PA Health Care Cost Containment Council directly at 717-232-6787.
How to Pay for Homecare
Payment Comes From Many Sources
Depending on your age, diagnosis or financial status, Medicare or Medicaid may pay for your care in the home. Also, private insurance offers coverage of homecare services and of course, you can pay yourself for care in the home.
Homecare insurance specialists help you verify coverage before services are provided. Most homecare providers take care of all paperwork and billing.
Medicare
Most Americans older than 65 are eligible for the federal Medicare program. If an individual is homebound, meaning he/she cannot leave the home without physical assistance, is under a physician's care, and requires medically necessary nursing or therapy services, he or she may be eligible for services provided by a Medicare-certified home health agency.
Depending on the patient's condition, Medicare may pay for intermittent skilled nursing; physical, occupational and speech therapies; medical equipment may also be paid for. The referring physician must authorize and periodically review the patient's plan of care. With the exception of hospice care, the services the patient receives must be part time and provided by a Medicare-certified home health agency for reimbursement. This means a nurse, therapist or home health aide comes to the patient's home for brief periods. Medicare does not cover care in the home for shift-type care - only specific tasks performed in concert by a nurse, therapist or home health aide.
Hospice services are available to individuals who are terminally ill and have a life expectancy of six months or less; there is no requirement for the patient to be homebound or in need of skilled nursing care. A physician's certification is required to qualify an individual for the Medicare Hospice Benefit.
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Medicaid
Medicaid is a joint federal-state healthcare program for low-income individuals. Pennsylvania's Medicaid program pays for homecare and has other programs for in home supports if people meet eligibility requirements.
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Private Insurance
Commercial health insurance policies typically cover some homecare services for when a person is recovering from surgery or illness. But benefits for long-term services vary from plan to plan. Commercial insurers, including Blue Cross and Blue Shield and others, generally pay for medical care in the home with a cost-sharing provision. Such policies occasionally cover personal care services such as help with meal preparation and light housekeeping. Most commercial and private insurance plans will cover comprehensive hospice services, including nursing, social work, therapies, personal care, medications, and medical supplies and equipment. Cost sharing varies with individual policies, but often is not required.
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Long-Term Care Insurance
As the public's need and preference for homecare has grown, private long-term care insurance policies have expanded their coverage for in-home care as well as nursing home care. Homecare benefits vary greatly among plans but most plans today cover homecare.
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Self Pay Insurance
People can arrange to pay for homecare services themselves if they desire. Homecare providers coordinate arrangements and billing. Rates and services available vary by provider.
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Other
There are other sources of payment for homecare services. These can include Workers Compensation, the Veterans Administration, CHAMPUS, the Older Americans Act and more. Many homecare providers have foundations that will pay for homecare for low-income families.
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