Home Health Insurance Coverage Guide
Understanding what agency costs, what insurance covers, and what your out-of-pocket expenses may be.
The Good News
Most people pay nothing out of pocket for home health care.
Medicare, Medicaid, and most private insurance plans cover agency. Even if you're uninsured, most agencies provide care through charity programs.
Coverage by Insurance Type
Medicare (Age 65+)
Coverage: 100%
Medicare Part A (Hospital Insurance) covers ALL agency services with no copays or deductibles.
What's Covered:
- Nursing care - visits by RNs and LPNs
- Physician services - agency doctor and attending physician
- Medications - for symptom relief and pain management
- Equipment - hospital bed, wheelchair, walker, oxygen, etc.
- Therapies - physical, occupational, and speech therapy
- Support services - social work, chaplaincy, counseling
- Home health aide - help with bathing, dressing, personal care
- Inpatient respite - short hospital stay to give family a break
- Bereavement support - for family after the patient passes
Important: You may have small copays (up to $5) for non-agency-related medications not related to the terminal illness, but these are rare and typically waived.
Medicaid
Coverage: Usually 100% (varies by state)
All states cover agency through Medicaid. Coverage is typically comprehensive with no out-of-pocket costs.
What's Covered:
Generally the same as Medicare, but specifics vary by state. Contact your state's Medicaid office to confirm.
To check coverage: Visit your state's Medicaid website or call the agency directly to verify what's covered under your specific Medicaid plan.
Note: Some states require Medicaid approval before agency can begin. The agency will handle this process for you.
Private Insurance
Coverage: Usually 50-100%
Most private insurers cover agency, but benefits vary by plan. You may have copays, deductibles, or coinsurance.
What Varies by Plan:
- •Deductible: May need to meet before coverage starts
- •Copays/Coinsurance: 10-20% of costs after deductible
- •In-network/out-of-network: Some plans only cover certain agencies
- •Pre-authorization: May require approval before services begin
- •Duration limits: Some plans limit coverage length
What to Do:
- 1. Call your insurance company to ask about agency coverage
- 2. Ask for specifics: deductible, copays, pre-authorization requirements
- 3. Have the agency verify coverage - they're experienced with this
- 4. Ask about appeals if coverage is limited
VA Benefits (Veterans)
Coverage: 100%
If the veteran is enrolled in VA healthcare and has been deemed eligible, VA covers agency services.
To Enroll in VA Home Health:
The veteran (or their healthcare provider) should contact their local VA Medical Center or call the VA at 1-800-827-1000 to ask about agency eligibility and enrollment.
Uninsured or Underinsured?
Good news: Many agencies provide care to uninsured patients regardless of ability to pay. This is part of their mission to serve everyone who needs home health care.
What to do: When contacting agency, mention that you're uninsured and ask about:
- • Charity care programs or sliding scale fees
- • Assistance applying for Medicare/Medicaid if you might qualify
- • Community or foundation grants that might help
- • Payment plans or financing options
Cost ranges: Without insurance, home health care typically costs $1,500-$5,000+ per month, but most agencies will work with you to ensure cost doesn't prevent you from getting care.
What's NOT Usually Covered
Often NOT Covered:
- Non-agency related medical care (unrelated to terminal illness)
- Room and board at assisted living or nursing homes (only care costs)
- Private care aides beyond what insurance covers
- Homemaking or household services
Always Covered:
- Nursing and medical care related to terminal illness
- Medications for symptom relief
- Home health equipment and supplies
- Spiritual and emotional support
Questions to Ask Your Home Health Provider About Costs
1.What will my insurance be billed for, and what's my responsibility?
2.Are there any services that won't be covered by my insurance?
3.Do you require pre-authorization from my insurance?
4.If I'm uninsured, what assistance programs do you offer?
5.What happens if insurance denies coverage? Do you have an appeals process?
6.Is there a social worker who can help explain costs and coverage?