Paying for Home Care

If you’re like many older Americans – or you have elderly parents – you probably have a lot of questions, such as:

• Does Medicare pay for home health care services?
• Does Medicare Advantage cover home care?
• What’s the average cost of home health care services?
• How much does private in-home nursing care cost?
• What home care services does Long-Term Care insurance (LTCi) pay for?

Each person has a unique situation – financially, health-wise and with family dynamics – so there isn’t a one-size-fits-all answer to the cost of in-home care services. But we can provide general insight here and meet with you one-on-one to discuss your loved one’s specific needs.

Home care can be a cost-effective option than many people realize and it’s an appropriate use of your loved one’s income and assets. Just as important – or perhaps even more important – is the fact that the majority of adults want to age in place, according to AARP®.

After all, your loved one’s heart is in their home. If their health allows them to remain at home supported by high-quality caregivers, finding a way to make that happen is one of the greatest gifts you can ever give them.

What’s the Best Way to Pay for Home Care?

Many people that find themselves at the beginning of the journey to bring caregivers or nurses into their home and have quite a few questions, such as:

• “How much does it cost for in-home care services near me?” The Genworth Cost of Care Survey is a good starting point for general cost information. Keep in mind that rates vary based on the types of services and the quality of care.
• “Does Medicare pay for home care services?” Refer to item #6 in the Your Plan to Pay for Home Care section below.
• “What resources can we use to cover the cost of in-home care?” This varies for each family and may change over time as your financial situation evolves.

Answering the questions below can help you identify sources of funds, which will help you prepare for a conversation with a BrightStar Care® agency or other home care service provider:

• What income, savings and assets does my loved one have available?
• Does he or she have assets they no longer need that could be sold? (e.g. Two cars, but only one of your parents still drives, a timeshare they no longer use, etc.)
• Did he or she or their spouse serve in the military?
• What health insurance do they have? What does it cover?
• Does your family member have traditional Medicare and/or Medicaid?
• Does your loved one have Medicare Advantage (MA)?
• Do they have Long-Term Care insurance (LTCi)?

In addition to the resources your loved one may have available for their own care, consider the availability of expendable income or assets you and your relatives may be able to contribute toward your family member’s needs.

What to Ask a Home Care Agency

When it comes to paying an agency, there are a few questions you’ll want to ask. Although answers to some of these questions will be included in the agency contract, it’s a good idea to get the details up-front:

• What forms of payment do you accept? (VA/CCN, private insurance, personal check, credit card, Long Term Care insurance (LTCi), government payers like VA/Military, Medicaid, etc.)
• How is billing handled? (mailed, online payment portal, emailed, etc.)
• What are your payment terms? (Pre-pay or deposit, weekly, net 30, due upon receipt, etc.)

Your Plan to Pay for Home Care

There is no single solution that works for every family. The right solution is the one that works for you. In many cases, the answer is likely to be a combination of the funding sources described below. 

Except for private pay, most options for home care services have eligibility requirements and limitations. Because rules surrounding sources like Medicaid, Medicare and Medicare Advantage (MA) sometimes change, we can help you navigate evolving details to support your efforts to provide for your loved one.

1. Private Pay or “Out of Pocket”

Paying with personal funds helps cover services when you or your loved one’s care has reached the limits of service and support from sources such as Medicare or other insurance coverage. These personal funds may come from your loved one or a family member who has the financial means to share in the cost of home care.

2. Private Health Insurance

Thanks to partnerships with national and local insurance companies, BrightStar Care® is sometimes in-network. Call us for more information – we are happy to do our part to facilitate getting quality care for your loved one. 

3. Long-Term Care Insurance (LTCi)

Long-term care benefits usually pay for in-home assistance with “activities of daily living” (ADLs) such as bathing, dressing, incontinence care, transfers (from bed, chair, toilet, etc.), meal prep and more. If your loved one has LTC insurance, BrightStar Care can help you process the claim; in some cases, we can assist with billing.

4. Military Benefits

VA health care benefits are available for eligible veterans and some benefits extend to the veteran’s spouse. Additional programs such as Aid & Attendance provide monetary funding to be used for home health care. Eligibility requirements vary so it is important to research which veterans programs may be a good fit. Call your local BrightStar Care agency today and they’ll help you determine if your loved one is eligible.

5. Medicaid

Each state decides what services are provided under their Home and Community Based Service (HCBS) waiver program. To qualify, your loved one must meet your state’s eligibility requirements, and have income and assets below certain guidelines. You can find general details about Medicaid here or your local BrightStar Care team may have additional insights.

6. Medicare (Traditional/Original)

Medicare Part A (hospital insurance) and/or Medicare Part B (medical insurance) cover eligible home health services as long as you need part-time or intermittent skilled services and as long as you meet the standards of homebound, as defined by the U.S. Centers for Medicare and Medicaid Services.

Medicare Part B (medical) covers some in-home care, but the type of service and frequency may be limited. Medicare-certified home health agencies provide service based on orders from a physician or allowed practitioner (such as a nurse practitioner, a clinical nurse specialist and physician assistant) usually for a specific condition and a set period of time.

Medicare Part A (hospital) offers the same coverage as Part B. However, under Part A, you may not receive home health services unless you were hospitalized for three (3) consecutive days just prior to needing at-home care.

BrightStar Home Care locations that offer skilled nursing may be eligible to provide “medically necessary part-time or intermittent skilled nursing care.” If your loved one is currently receiving care from a Medicare home health agency, BrightStar Care (which is a home care agency) will work with the Medicare agency to provide the supplemental or continued care. 

Every situation is different. You may be affected by a Medicare demonstration program if you receive services in Florida, Illinois, Massachusetts, Michigan, or Texas. Learn more with a free booklet, Medicare and You, from the official Medicare website. This booklet is available in multiple languages, Braille, audio, large print, e-reader options and on paper. You can also visit the home page of the Medicare site or call 1-800-MEDICARE (1-800-633-4227). 

7. Medicare Advantage (MA)

Medicare Advantage (also called Medicare Part C) is an alternative to traditional Medicare for your healthcare insurance that often includes benefits not covered by traditional Medicare, such as dental, vision, drug coverage and supplemental benefits like personal care and homemaker services. 

There are many insurance carriers and MA plans available with differing benefits, so it is important to understand what coverage you have. Our team is here to help you sort through details regarding whether you may qualify for In-Home Supplemental Services (IHSS).

8. Program of All-Inclusive Care for the Elderly (PACE)

This newer, relatively small program may be a source for home care funds. PACE provides comprehensive medical and social services to certain frail, elderly people (participants) still living in the community. Most of the participants who are in PACE are dually eligible for Medicare and Medicaid.

Lean Into Our Experience

Most individuals will only deal with home care services a handful of times throughout their lives – for their parents, their spouses, a child with a disability or even themselves.

But at BrightStar Care, we think about home care services 24/7, every day of the year. We are ready to be your trusted source of information and guidance on this important issue. We hope you’ll reach out for assistance.

If you would like to learn more about in-home care, please send us a message, reach out to your nearest BrightStar® Home Care agency or return to the beginning of our online Home Care Guide.

This overview is designed to serve as general information and should not be taken as financial advice.
** https://www.va.gov/GERIATRICS/pages/Home_and_Community_Based_Services.asp?utm_source=geriatrics_left_menu
**** https://www.medicare.gov/coverage/home-health-services
****** https://www.cms.gov/medicaid-chip/medicare-coordination/qualified-beneficiary-program/program-all-inclusive-care-elderly-pace