The realization that your parent or elderly loved one requires home health care means many things, including determining who will pay for the service. Whether Medicare or other coverage pays for your loved one’s home care service depends on the health of the individual and related factors. Some private nursing services are not covered by medical insurance plans.

Let’s review coverage factors and options to help you determine who pays for your loved one’s care:

Medicare Homebound Criteria

In order to receive Medicare Home Health Benefits, your loved one must meet certain criteria. The person must be homebound, meaning he or she cannot leave the residence without “considerable and taxing effort” and assistance from another person or transportation service. “Homebound” is also defined as a person who is unable to leave their residence for long periods of time. Temporary circumstances qualify as well, such as the recovery period from a serious illness or injury.

Additional Medicare Criteria

Additional Medicare Home Health Benefits criteria include the patient requiring at least part-time or intermittent care. The patient also needs a signed physician’s order requesting service and at least one skilled professional service, such as speech or physical therapy. Service must be through a Medicare-Certified Home Care Agency and take place at the person’s main residence.

Medicaid & Private Pay Options

Medicaid generally covers the same services as Medicare Home Health Benefits. It is designed for those who do not have the funds to pay some or all of their medical expenses. State law determines financial eligibility for Medicaid health insurance.

Private pay is also an option if your loved one’s home care services are not covered by Medicare, Medicaid, or other insurance options. For example, companion services are usually not covered.

Discuss home health care payment with the compassionate team at CareResource Hawaii to determine if your loved one’s elderly assistance services are covered by insurance. The Honolulu, HI-based home health care service provides outstanding personal care, post-operative services, and specimen collection. Contact CareResource Hawaii today about elderly assistance by calling (808) 871-2115 or visiting their website.

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