The simplest way to pay for home care is to do so privately; i.e., out of pocket, as you would for any other service. This affordable option maximizes your flexibility and control over your care without requiring you to coordinate with third parties.
However, government programs and private insurance will pay for home care under specific circumstances:
Medicare covers home care when the client: 1) Cannot leave home without physical assistance; 2) Is under a physician's care; and 3) Requires skilled nursing or therapy services. The state Medicaid program covers home health for low-income individuals under similar requirements.
The Massachusetts Home Care program provides state-funded, non-medical services to elders and disabled individuals who meet certain financial guidelines. These supportive services enable frail elders to remain in their homes and target those at risk of needing nursing home care. They can be accessed locally through by calling (800) AGE-INFO or www.800ageinfo.com.
Commercial health insurance typically covers some home care services when a person is recovering from injury, surgery, or temporary illness, but will not pay for most chronic conditions. Benefits vary from plan to plan and usually contain a cost-sharing provision. Check your policy and insurer for details on coverage requirements, benefits, co-payments, and deductibles.
Long-term care (LTC) insurance policies almost always cover home care as an alternative to a nursing home. The home care benefits under these policies are usually capped at a certain dollar level per day, week, or month; as always, check your policy.
The Veterans Administration (VA) pays for home care services for veterans who are at least 50% disabled due to a service-related condition. A physician must authorize these services, which must be delivered through the VA's network; it only covers medical services.