via the National Association for Home Care and Hospice
When services are covered by Medicare and/or Medicaid, home care
providers must bill their fees directly to the payor to Medicare or
Medicaid. Providers often will bill other third-party payors directly as
well. Any uncovered costs are later billed to the client. However, if a
client receives services from a registry or independent provider, he or
she must pay the provider directly. Later the client may file for
reimbursement from the insurance company if the services qualify as
covered benefits. Payment options are detailed below.
Home Health Agencies
Medicare, Medicaid, and most private insurance plans pay for services
that home health agencies deliver. Payment from these sources depends on
whether the care is medically necessary and the individual meets
specific coverage criteria. Individuals may opt to pay out of pocket for
services that are not covered by other sources. Some agencies receive
special funding from state and local governments and community
organizations to cover the costs of needed care when other options are
Coverage for hospice care is available through Medicare, Medicaid
programs in 38 states, and most private insurance plans. If insurance
coverage is insufficient or unavailable, the patient and his or her
family may pay for services out of pocket. Most hospices may provide
free services to individuals who have limited or no financial resources.
Homemaker and Home Care Aide Agencies
Individual consumers usually pay for services from homemaker and HCA
agencies. However, some states contract with these agencies to deliver
personal care and homemaker services within their social services and
medical assistance programs. On rare occasions, commercial insurers may
pay for a portion or all of the costs of these services. Some agencies
draw assistance from charitable community funds when other sources of
payment are not available.
Staffing and Private-duty Agencies
Typically, the individual or his or her commercial insurance carrier
pays for services provided by staffing and private-duty agencies,
provided that the insurance policy's coverage requirements are met. Some
staffing agencies contract with state Medicaid programs to provide
nursing and personal care services.
Pharmaceutical and Infusion Therapy Companies
Pharmaceutical and infusion therapy supplies and services are almost
always paid for by commercial insurance companies and Medicaid. Medicare
covers the cost of nutritional supplements and certain medications when
the situation meets strict coverage.
Durable Medical Equipment and Supply Dealers -
Fees for durable medical equipment and supplies are usually covered by
Medicare, Medicaid, and commercial insurance programs, provided that the
products are ordered by a physician and are medically necessary to
treat an illness or injury.
The individual client generally pays for registry services. In some
cases, commercial insurance companies may reimburse a portion or all of
Usually the individual pays for services rendered by independent
providers. Some commercial insurance policies will provide reimbursement
if the services qualify as covered benefits.