Medicare
Home Care or Home Maker Services are a Non-Medical or Non Skilled service and therefor not a usual and customary service covered by most health insurance plans. It is also not covered by Medicare, Medicare Advantage, Medicare Replacement or Medicare Part C plans.
Fortunately, there are a few payor sources like Medicaid, Long-Term Care Plans, and The Veterans Administration (V.A.) that does cover this vital service. Otherwise, this is an out of pocket cost or expense for the individual(s).
State Medicaid & Long Term Care Insurance
For both Medicaid and Long-Term Care Plans, the company providing the services must be contracted with the insurance carrier for the specific plan the insured client is a claimant on. They must follow the insurance company’s guide lines, payment or fee schedule, and bill them directly. The individual receiving the care will usually need to meet medical necessity which usually involves getting a referral or order from their primary care. Then, have medical case review for approval which in some cases can take from 1-2 weeks to a couple of months.
The good news for the individual client is that if they qualify, there is usually no out of pocket cost to them.
Veterans & The VA
For qualified Veterans, the VA does provide two separate options to cover these services. The first option or pathway for Veteran’s needing home/personal care is to be seen at a VA Facility were the primary care provider submits a referral to the Integrated Care Services for Care Coordination. The VA Utilization Review Nurse then review and if approves the care, the VA will contact a contracted company/vendor on their list of approved provides for these services. Once approved, the company providing the services will provide the services to the individual and bill the VA directly for payment. Payment for services rendered will be paid directly to that agency at the contracted rate. In this pathway, our Veterans are not burdened with billing and payment issues but still receive the care needed to remain in the comfort of home.
The second option for Qualified Veterans is to first submit a claim for Benefits & Eligibility with the VA. Then, if qualified, the Veteran will have his/her primary care doctor complete the Aide and Attendant Care Form and submit it to the VA. Once approved, the VA will notify the Veteran and the Primary Care Provider of approval. The Veteran is then given an additional monthly stipend to cover these services. The Veteran is then required to coordinate and pay for these services from the allocated stipend given them monthly for these services. The Veteran is free to contract the agency of their choice for themselves and must keep record of such transactions or risk lost of stipend.
In either case, any Veteran can contact their local Veteran Service Officer (VSO) for help to file their claim. This is a free service to all veterans and can save weeks or even months on approval for their claim as the Department of Veterans Affairs and Veterans Administration can be overwhelming.
Direct Pay or Out of Pocket
Cash or direct payment out of pocket is the most common payment source for clients and their families to cover the cost of these services. There are many factors that will need to be considered when it comes to invite someone to come into your home and care for yourself or a loved one. Back To Basics Home Care, LLC, can help you to make the right choice!
Contact us for a free consultation and free home inspection to ensure a safe environment and prevention of potential injuries and you continue to research your options.