Cost & Insurance Navigator
Demystify agency costs. Learn what Medicare covers, how to verify your insurance, and what questions to ask.
Understanding Home Health Coverage
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Medicare Coverage
Medicare Part A covers home health care for patients with a prognosis of 6 months or less. Coverage includes nursing, doctors, medical equipment, medicines, and other services related to the terminal illness.
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Medicaid Coverage
Most state Medicaid programs cover home health care. Coverage varies by state, so check with your specific state's program for details about what's included.
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Private Insurance
Many private insurance plans cover home health care. Your insurance company can tell you what agency services are covered and what your out-of-pocket costs might be.
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Veterans Benefits
Veterans may be eligible for home health care through the VA or through VA-partnered community agencies. Contact your local VA medical center for details.
What Home Health Services Are Covered
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Nursing Care
Regular nursing visits and 24/7 on-call availability for questions and emergencies.
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Medical Equipment & Supplies
Hospital beds, wheelchairs, walkers, oxygen, wound care supplies, and other medical equipment.
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Medications
Medications related to the terminal illness and symptom management, including pain medications.
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Home Health Aides
Assistance with bathing, grooming, toileting, and other personal care needs.
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Physician Services
Doctor visits, consultations, and oversight of the care plan.
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Counseling & Support
Social work, spiritual care, grief counseling, and emotional support for patient and family.
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Respite Care
Short-term inpatient care to give family caregivers a break (typically 5-7 days, up to 5 times per benefit period).
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Bereavement Support
Grief counseling and support for family members after the patient's death (typically for up to 13 months).
What Costs Might You Have?
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No-Cost Home Health Services
If you have Medicare or most insurance plans, home health care is covered with no copay or deductible. The agency agency is paid directly by your insurance.
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Routine Medications
Medications related to your terminal illness are covered. Regular medications for other conditions may still be your responsibility.
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Room & Board (Inpatient)
If care is provided in an agency facility, nursing home, or hospital, Medicare covers agency services but the facility may charge for room and board.
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Services Not Related to Terminal Illness
Treatments, medications, or tests for conditions unrelated to the terminal illness may not be covered.
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Uninsured Patients
If uninsured, talk to the agency agency about financial assistance programs and sliding scale fees.
How to Verify Your Coverage
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Call Your Insurance Company
Ask specifically about agency coverage, what services are included, and whether prior authorization is needed.
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Ask About Home Health Agency Networks
Your insurance may have preferred agency providers. Using an in-network provider could save you money.
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Get Documentation in Writing
Ask for written confirmation of coverage details. This protects you if billing issues arise later.
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Confirm Medicare/Medicaid Status
Make sure your Medicare or Medicaid is active and up-to-date. Problems here could delay or deny coverage.
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Ask About Out-of-Pocket Maximums
Understand what your maximum out-of-pocket costs could be, especially for any non-covered services.
Questions to Ask Your Home Health Provider
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What is your billing process?
How will you bill insurance? Will you contact my insurance company directly?
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What happens if my insurance denies coverage?
Will you appeal the denial? What costs could I be responsible for?
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Are there any services I might be billed for?
Are all services covered by insurance, or might some have out-of-pocket costs?
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Do you accept Medicaid/Medicare?
Confirm that the agency agency accepts your specific insurance.
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Do you have financial assistance programs?
If uninsured or underinsured, ask about grants or sliding scale fees.
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What's included in your daily rate?
Get clarity on what services and supplies are included in the quoted cost.
Financial Planning Tips
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Plan Ahead if Possible
If you know agency is coming, verify coverage before it's urgent. This reduces stress and prevents surprises.
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Ask About Advance Directives
Having an advance directive and healthcare power of attorney in place can prevent costly legal battles later.
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Review Final Expenses
Understand funeral and burial costs separately from home health care. Many are not covered by insurance.
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Look Into Medical Debt Programs
Some agencies and hospitals have programs to help with medical debt. Always ask.
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Keep Detailed Records
Save all bills and insurance correspondence in case you need to dispute charges or submit appeals.
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