Who Pays for Home Care?

For most home care to be covered by public and private payers, it must be considered medically necessary. You must also meet certain coverage requirements. Different insurance plans have different policies. Check your plan to see what is covered.

Government programs

• Medicare covers certain home health care costs through the Part A and Part B. See their website for information.
• Veterans' Administration (VA) benefits also cover some home health care. See their website for information.
• Medicaid requires states to provide home health benefits to those in need. However, programs are different in each state. Find more information about your state's Medicaid program.

Private third-party payers

• Commercial health insurance companies: Many private insurance companies cover skilled medical care but not personal care. Coverage often depends on whether the care is medically necessary and if a person meets the criteria spelled out in the plan. Contact your health care plan to get details about what your insurance will cover. Also, check to see if you need pre-approval.
• Managed care organizations: Some plans through managed care organizations (MCOs) cover home health care services. MCOs that have contracts with Medicare must provide all the home health services that Medicare covers. Check your plan’s coverage and whether services need to be pre-approved.

Private pay or self-pay

• Self-pay: If you don’t have insurance or the insurance doesn’t cover all the care that you need, you and your family can hire providers and pay for services yourself. It may help to shop around, as these services can be expensive.
• Community organizations: Some community groups, and state and local governments, help pay for home health and personal care. Some agencies get donations from individuals and charity groups to provide care to anyone who needs it, whether or not they can pay. Depending on a person’s eligibility and financial need, these groups may pay for all or part of services. Hospital discharge planners, Local offices on aging, the United Way, and your American Cancer Society can help you find out what’s offered in your area.

Other options

Long-term care insurance and cancer insurance policies sometimes will pay for these services, but it depends on your policy or plan. Check with your plan or policy to see if you have coverage for home care services and if there is a waiting period to access payment for services.