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Who Pays for Home Health Care?
Professional home care services can be paid for directly by insurance, community entitlement programs or by the patient and his or her family.
Below, you will find basic information about the various programs. If you, or your family member lives in CT, please feel free to contact our VNA Help Line at 866.474.5230 (toll free).
• Medicare Advantage Plans
• Private Health Insurance
• Veterans’ Administration
• Long Term Care Insurance
• Medigap Insurance
• Entitlement Programs
Medicare pays for professional home care services for eligible senior citizens if they meet fairly strict criteria. Medicare covers nursing and physical, occupational and speech therapy services. It will also cover social work and home health aide services if nursing or therapy service is present. Medicare does not cover companions or homemakers.
Medicare Home Care Rules
Medicare Advantage Plans
Managed care plans often include coverage for home health care services. HMOs usually require prior authorization for home care and the use of a home care agency that participates in the HMO network. Medicare Advantage plans are managed care plans for seniors. These plans provide the same benefits as regular Medicare including home care, but many plans require prior authorization for home care services. (Call CHOICES health insurance counseling program at 1-800-994-9422 or Aging Services Division, Department of Social Services for further information)
Private Health Insurance
Private health insurance typically covers some home care services for acute needs. Benefits for longer term care vary by plan. Most private plans will cover professional home care services with the patient responsible for cost-sharing. Prior approval is usually required, especially for managed care plans.
Medicaid is a joint federal-state medical assistance program for low-income individuals. States are required to provide home health services to individuals in certain categories such as aged, blind or disabled. Medicaid covers nursing care, home health aide care and limited therapy services.
Veterans who are at least 50% disabled due to service-related conditions are eligible for home care. A physician must authorize these services. Contact the Connecticut Department of Veterans’ Affairs Info Line at 1-866-928-8387 for further details.
Long Term Care Insurance
Many long term care insurance programs cover home care personal care services if specific conditions are met. Long term care policies use "benefit triggers" to determine whether home care will be covered. One common trigger is the inability to perform a certain number of activities of daily living without assistance. Most plans require an elimination or waiting period before services become covered. During this period, the patient must pay for his or her own care. The Connecticut Partnership for Long-Term Care Insurance provides independent information on how to choose a policy and a list of the companies who sell the policies in Connecticut.
Medigap Insurance is designed to bridge gaps in Medicare coverage. A few of the more comprehensive Medigap policies offer home recovery benefits that pay for personal care services when the member is receiving Medicare covered skilled home health care benefits. A patient’s physician must order this care.
Home care services that do not meet the criteria of insurers or government programs must be paid "out of pocket" by the patient or family.
(Call CHOICES counseling program at 1-800-994-9422 for further information)
Connecticut Home Care Program for Elders
Federal funds to state and local agencies help provide home care services for individuals over age 60 who are at risk for placement in an institution and who meet income and eligibility guidelines. The Home Care Program provides professional case management and coverage for nursing, therapy, home health aide, homemakers, medical alert services and, in certain cases, transportation.
Connecticut’s National Family Caregiver Program
This program will pay up to $3,500 for respite services, such as home health aide, homemaker, companion, nursing care or short term nursing facility stays. Families must submit an application which states their income. Funding priority is given to individuals with the greatest social and economic needs.
Connecticut Statewide Respite Program
Program provides up to $3,500 for individuals with Alzheimer’s or related dementias to receive home health aide, homemaker, companion, nursing care or short term nursing facility stays. There are income and asset limits for this program.
Other entitlement programs may be available. Inquire by calling CHOICES (1-800-994-9422). Also, contact the Municipal Agent in the town where the senior lives about other sources of financial assistance