Determining how to pay for home health services is one of the first things that patients and their families consider. Below are answers to frequently asked questions about how to pay for home health:


    When does Medicare pay for home health?

    Most Americans older than 65 are eligible for the federal Medicare program. To qualify for Medicare home health, you must meet the following requirements:

    1. A physician must determine (order) that you need a skilled home health service.
    2. A physician must develop and sign a plan of care.

    3. You must be homebound. This means you have an inability to leave home and, therefore, leaving home requires a considerable and taxing effort. Occasional absences from the home are permitted as long as they are of short duration. For example, doctor appointments, family reunions, funerals, religious services, or graduations will not disqualify you from home health services as long as they do not indicate you have the ability to obtain services in a setting other than your home.

    4. You must need one of the following services intermittently (part time): Skilled nursing / physical therapy / occupational therapy or speech therapy.


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    What services does Medicare Home Health cover?

    • Skilled nursing (RN or LPN)
    • Physical therapy, speech therapy, and occupational therapy if the doctor determines that you can benefit from therapy.
    • Home health aide services for assistance with personal care such as dressing, bathing, or toileting as long as you are also getting other skilled services listed above.
    • Medical social services to assist with social and emotional issues related to your illness.
    • Certain medical supplies, like wound dressings, but not prescription drugs.

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    What services does Medicare Home Health not cover?

    • 24-hour care / live-in care
    • Prescription drugs
    • Meals delivered to your home
    • Homemaker services such as laundry, cleaning, shopping
    • Transportation
    • Medical alert devices

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    Who qualifies for Medicaid?

    Medicaid is available only to certain low-income individuals with little savings and no other significant assets who fit into an eligibility group that is recognized by federal and state law. Benefits vary in each state, but typically cover skilled nursing, physical therapy, home health aide services and certain medical supplies and equipment. Unlike Medicare, Medicaid may also pay for homemaker or personal care services.

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    What does private insurance usually cover?

    Insurance plans primarily offer skilled nursing, physical therapy and home health aide services for acute needs. Co-pays and/or deductible payments are common. Frequency of visits are authorized in advance and closely monitored by insurance case managers.

    Benefits vary in each state and private insurance carriers have different policies. Our expert financial staff can help you understand your coverage provisions and will contact your insurance company to determine your benefits.

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    When is self pay the main option?

    Self pay is an option when a patient does not qualify for one of the above plans or would like to supplement services above what the plan will cover. Typically services are priced on the basis of per visit (up to 2 hours) or per hour.

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Victorian Home Care is a licensed home care agency, offering personal home care assistance to families throughout Monterey and Santa Cruz Counties. With offices in Monterey and Aptos, our service area includes Monterey, Pacific Grove, Carmel, Salinas, Seaside, Castroville, Watsonville, Aptos, Capitola, Santa Cruz, Scotts Valley, and surrounding cities. Services include hourly or live-in home care, extended care, home health aides, medication reminders, and coordination with healthcare providers. Home caregivers and personal care assistants provide help with activities of daily living, meal preparation, light housekeeping, senior and eldercare, Alzheimer’s and dementia care, transportation and companionship. We are an affiliate of Kindred at Home.