As with all medical-related things, there is no short answer to the question of whether your insurance covers in-home care. Every insurance policy is different, and depending on if you qualify for Medicaid, the answer will vary.
While there may not be a short answer, here are a few things to consider and keep in mind as you do your research.
If You Have Private Insurance:
If you have your own insurance and don’t use medicare or medicaid, then you’ll need to contact your insurance company or review your policy to find your answer. Unfortunately, there’s no way for you to do a quick Google search and get an answer. Instead, you’ll have to look at your unique insurance policy.
In many cases, you can use private insurance to cover the gaps in your medicare plan. As you’ll see below, only two parts of medicare cover in-home care. If you don’t benefit from either of these parts, then you may be able to find a private insurance company that will cover in-home care while you continue to benefit from the medicare policy you do have.
If You Have Medicare:
There are a few different parts to Medicare, so if you do benefit from it, you’ll need to know which part you’re covered by. In some cases, you may benefit from more than one part, so as long as you benefit from at least one of the sections that include in-home care, you’ll be able to get it covered.
Medicare is based on age or diagnosis, not income. To qualify, you must meet at least one of the following conditions:
- Be over 65 years old
- Have certain disabilities
- Receive a qualifying diagnosis, such as end-stage renal disease
Due to the four different parts of Medicare, it’s essential to know which ones you’re covered by to know if in-home care is covered for you.
Only parts A and B will cover in-home care, but you must meet certain situations even then.
With Part A, you must be homebound and have a skilled need that requires a professional such as a nurse or physical therapist. Both must be true for Medicare to cover your in-home care. As soon as one situation ceases to be true, Medicare will no longer cover in-home care.
This does not include physical therapy, occupational therapy, or home health aide. OT, PT, and HHA may be treated as in-home care if it is in addition to the first two needs above, but they do not qualify as a need themselves.
With Part B, physical therapy and occupational therapy do count. Additionally, a patient does not need to be homebound in order to benefit from in-home care through medicare.
If You Have Medicaid:
Medicaid is different from Medicare, although they sound similar. It’s an income-based program that is funded by the federal government and the state government. Qualifying criteria are determined based on the Federal Poverty Level Table.
Covered individuals qualify for in-home care when it is medically necessary. However, depending on your state, coverage and qualifications for it may vary, so it’s important to double-check with your state to ensure you get a clear answer as to whether your specific situation qualifies.
Depending on your insurance situation, you might be fully covered for in-home care. Unfortunately, you won’t get a simple generalized answer about whether your insurance covers it for you. You’ll need to do some research to learn more about what your specific insurance company covers and what qualifications you may need to meet before your care is covered. Thankfully, in many cases, getting in-home care covered isn’t too complicated.