Cost & Eligibility

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Our care programs offer unique services tailored for specific situations. Some types of care are paid for by Medicare and Medicaid. Others may be covered by long-term care insurance. Some may need to be paid privately.

If you have questions, ask us. We can help you find out which program is the best for your situation and what is and isn’t on your plan.

Below are the eligibility requirements and usual coverage arrangements for each of our programs:

Home health care

Home health care involves home visits by medically trained specialists to patients who are unable to leave the house and come to an office or clinic. The goal is to restore the patient’s ability to live as healthily and independently as possible. Or at least maintain the patient’s current health and abilities and not lose ground.

Eligibility:

  • Patient must need skilled care by a trained professional. Typically, this means a nurse, a physical therapist, a speech therapist, a dietician, a social worker, etc.
  • Patient’s need for care is medically necessary and part of generally accepted practice for the condition.
  • The care needed is part time and intermittent. (This is not for having someone live in the home. It is for periodic visits now and then.)
  • Patient must be “homebound,” meaning due to illness or disability, he or she cannot go out for much more than medical care, and worship.
  • Patient must have an order from a physician requesting home health services.

Cost:

Depending on your insurance, and as long as you meet the eligibility requirements, most home health services are covered according to your plan. This means you are still responsible for any deductible or co-payments.

Medicare, for example, covers 80% of home health services. If you have a Medi-gap (supplemental) policy, usually they will pick up the 20% of what Medicare doesn’t cover. (Be sure to tell the doctor you have supplemental insurance so he or she can file any necessary paperwork.)

There may be services, equipment or supplies that are not covered by your insurance. If that’s the case, we will let you know so you can make choices.

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Personal care

It may be that your loved one needs help around the house. Tasks such as laundry, shopping, cooking, housekeeping. Or he or she may have intimate care needs: toileting, bathing, dressing, grooming. This type of personal care does not require medical training. As such, it is not usually covered by standard health insurance or Medicare. Most people need to pay for personal care privately (out-of-pocket). There are no eligibility requirements in that case.

If you have long-term care insurance, check with your insurer. (Or give us a call at [Your Phone Number] and we will check for you.) Some policies cover personal care for specific conditions.  There may be a waiting period (90-180 days).

Veterans benefits sometimes cover “Aid and Assistance.” This is dependent on the length of your loved one’s service. It is often tied to how much he or she was involved with active combat.

Medicaid programs for low income individuals will sometimes cover personal care. Check with your case worker.

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