Paying for Home Care Services

Home care services are paid for through a variety of sources. The Federal Medicare program will pay for medically-necessary home care services, generally for a limited duration and most typically following a hospital stay. The same is true for most private health insurance plans. New York's Medicaid home care programs provide a wide range of services to those who qualify. Long-term care insurance is an increasingly important option for many people as it pays for home care services as well as nursing home services on a long-term basis. Thousands of New York State residents also purchase home care services privately.
Government Programs

Most Americans over age 65 are eligible for the Federal Medicare program and some under age 65 are eligible because of disability. To qualify for home care services, a person with Medicare must be homebound, under a physician’s care and must need medically necessary skilled nursing or therapy services. Medicare pays for home health benefit services based on a 60-day episode of care.

Medicaid is a joint Federal-State medical assistance program for low-income individuals that is administered by the states. Each state has its own set of eligibility requirements. In New York, the New York State Department of Health (DOH) regulates the home care service programs that are available to certain Medicaid-eligible people under the State's Medicaid program.

The New York State Office for the Aging (NYSOFA) regulates home care programs that are provided through county offices for the aging, including the Expanded In-Home Services for the Elderly Program for elderly people who do not qualify for Medicaid.

Other Payment Options

Private Insurance
A variety of different types of insurance is available to cover home care needs.

Health Insurance
Commercial health insurance policies normally include a home health benefit covering services for acute needs. Most plans will also cover comprehensive hospice services. Many people with Medicare coverage purchase private “Medigap” policies to cover services that Medicare does not that may include home care services. Some Medigap policies offer benefits that pay for personal care services when the policyholder is receiving Medicare-covered skilled home health services.

Long-Term Care Insurance
Long-term care insurance is becoming an increasingly popular way for individuals to prepare for the eventual need for long-term care services. Originally developed as a way to cover lengthy stays in nursing homes, private long-term care policies have expanded their coverage of personal care and other home services. Home care benefits vary among plans and there may be limitations and exclusions. 

Workers' Compensation
Someone with medically necessary home care needs as a result of an injury on the job can receive coverage through workers' compensation.

Self-pay or Private Pay
Individuals who are not covered for home care services by any of the third-party options may pay directly for services, negotiating fees with the home care agency.