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Paying for Home Care

When you or a loved one needs home health care, the last thing you want to worry about is how you’ll pay for it. At the Visiting Nurse Service of New York, we’ll work with you to determine your specific coverage and help you access the care that’s needed. We accept a variety of payment options for home health care services and even offer health plans to some eligible New Yorkers. The following are some of the ways you may be able to pay for our home care services:

Does Medicare Pay for Home Health Care?

Medicare is a federally funded program, primarily for those 65 and older. Medicare may pay for visiting nurses and other home health care services, including part-time skilled nursing care, part-time home health aides, rehabilitative therapy (including speech, physical, and occupational therapies), social services, and medical supplies. It does not cover around-the-clock home care, meal delivery, or assistance with shopping or domestic chores.

In order to qualify for Medicare home health care, a patient must be homebound and in need of part-time skilled nursing care or rehabilitative therapy. Your doctor must order Medicare services, as well as formulate a plan of care for the home health care organization, such as VNSNY, to carry out. Your doctor and your VNSNY nurse will work closely to determine which services and supplies are needed and how often, as well as what progress should be expected and how long you need home health care.

Before your home health care services can begin, VNSNY will inform you in writing about how much of your bill should be covered by Medicare, as well as which items and services are not included in the coverage and their costs. VNSNY bills Medicare, which pays the full, approved cost of all covered home health care visits. Any remaining costs are the patient’s responsibility (but may be paid for by another form of insurance).

For eligibility requirements and coverage information regarding Medicare, please visit the Medicare website or call 1-800-633-4227.

Does Medicaid Pay for Home Health Care?

Medicaid is a health insurance program funded by federal and state governments that is available to United States citizens and permanent residents who meet certain requirements for income, resources, age, or disability.

In general, Medicaid covers most skilled nursing care, whether at home or in a facility, and personal care provided by a home health aide. Medicine, supplies, and equipment, as well as transportation to and from medical appointments, may also be covered. (Some services, equipment, and supplies may require prior approval before they can be covered.)

In order to help your family member get the health care required, it is important to plan ahead for Medicaid eligibility and to learn the rules necessary for Medicaid application so that you know what is required and how to comply.

Medicaid Eligibility

To find out if you meet eligibility requirements, visit Medicaid in New York State or contact the following office in your area:

  • In New York City: the Human Resources Administration by calling 1-718-557-1399 (residents of the five boroughs of New York City may call toll free at 1-877-472-8411).
  • In Nassau County: the Nassau County Department of Social Services by calling 1-516-227-7474.
  • In Westchester County: the Westchester County Department of Social Services by calling 1-914-995-5000.

Medicaid applicants must show proof of age and citizenship, a Social Security card, proof of current income and assets, and a Medicare benefit card.

Does Private Health Insurance Pay for Home Health Care?

Private health insurance, such as employer-sponsored as well as individually-purchased insurance, managed care programs, and long-term care insurance, may cover some home care services (including skilled nursing care, rehabilitation therapy, or services provided by a home health aide). It may be an option for those who don’t participate in a government insurance program or who desire more services than these programs cover.

Plans sponsored by an employer (or if you’re retired, a former employer), and those purchased by an individual often cover home health services for limited periods. Check with your plan administrator, benefits coordinator, or insurance representative to verify what your policy covers and whether home health services require an authorization.

VNSNY accepts a wide variety of managed care programs and Medicare Advantage plans, including those offered by our subsidiary company, VNSNY CHOICE. Check with your managed care company to verify that VNSNY is a participating home health care company and whether home health services require an authorization. Learn more about the managed care plans offered by VNSNY CHOICE.

Whether provided by an employer or purchased individually, LTC generally provides specific dollar payments for insured persons who require assistance with activities of daily living. Policies vary in terms of how much assistance is covered, and by benefit amounts. Be sure to check with your provider to verify that your plan covers what you think it does.

Private Pay for Home Health Care Services

Private pay (paying out of pocket) may be an option if you need home health care services (including skilled nursing care, rehabilitation therapy, or services provided by a home health aide) but don’t qualify for a government insurance program, if you don’t have private insurance, or if you desire more services than these programs cover.

For several reasons, many seniors and their families choose to pay out-of-pocket for private care:

  • Paying out-of-pocket gives you greater flexibility in the type and amount of services you order.
    • In some cases, a patient’s Medicare coverage or other private insurance coverage may not pay for all of the home health care services needed or wanted.
    • It may be that the benefits have been exhausted, or perhaps the patient’s medical needs do not qualify them for covered home care services.
  • You can avoid the restrictions and limits of programs provided by the government or private insurers.
  • Many people find that home health care costs are typically much lower than fees at residential health care facilities such as nursing homes, assisted living, or memory care facilities.

If you are a VNSNY patient, or the caregiver of one, and you would like more services than Medicare or a private insurance company will cover, you can supplement the covered services by choosing to pay for private care while still maintaining care that is reimbursed by Medicare. In addition, you can arrange to keep the same home health aide when you use VNSNY for the Medicare portion of your services and our affiliate, Partners in Care, for the private care. Best of all, when using both VNSNY and Partners in Care services together, your private care services are provided at a reduced rate.

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