One of the most important first steps in a long-term care plan is establishing how to pay for in-home care. Fortunately, there are various ways to pay for in-home care, including some insurance policies.
Knowing what insurance covers in-home care, what services are covered, and what’s required to access insurance coverage is essential to keeping costs as affordable as possible.
Scheduling free, in-home assessments with licensed, local home care agencies is the best way to learn more about home care costs and what insurance covers in-home care.
Understanding Home Care Costs & Insurance Coverage
Home care costs vary according to the type of care required, geographic location (home care costs fluctuate with living costs), and how many hours of care the client needs.
The most recent cost assessments for home care in the Inland Empire are:
- Home Health Aide: $5,302
- Assisted Living Facility: $4,635
- Nursing Home (semi-private room): $8,145
- Nursing Home (private room): $9,305
Home Health Aide costs are factored on a 40/hour per week schedule, and those hours include any services offered by the agency—so there are no hidden fees or up-charges.
On the other hand, assisted living facility fees are quoted as a “base price” and do not include the extra costs tagged on to things like meals brought to rooms, mobility support, toileting/incontinence care, laundry and linen changes, outings, and activities, etc.
In most cases, clients use a variety of sources to fund aging-in-place, many of which include insurance of one type or another. The following are some of the most common insurance providers that cover some aspects of home care costs, depending on the client’s diagnosis, medical needs, prescriptions, etc.
What Insurance Covers In-Home Care
We can’t emphasize enough how much free assessments with local home care agencies help with understanding which situations qualify for insurance support and which do not. These assessments are 100% free of charge and carry no obligation. They provide a wealth of information about what’s required for loved ones to age in place with dignity, independence, and a high quality of life.
Here is a general overview of which types of insurance cover in-home care services:
Medicare Part A (Hospital) & Part B (Medical Insurance)
Medicare insurance policies can be used to cover some aspects of home care but only those that are:
- Medically-related
- Ordered by a physician
- Considered short-term or temporary
In these cases, Medicare works with healthcare providers, covering medical-oriented care which may include home care from a Medicare-certified home care agency.
In most cases, Medicare pays for things like:
- Home health assistance
- Durable medical equipment
- Home health care that supports skilled nursing, PT or OT, and other services ordered by the doctor
- Personal care that supports hygiene and daily living activities (bathing/showering, bathroom care, dressing, etc.)
- Other services—as long as your doctor certifies—that you are homebound
In most cases, Medicare does not cover the costs for basic housekeeping, full-time care, meal preparation, or other services not covered by your medical care plan. That said, there are cases where post-operative patients may have some of these services covered for a short time to support a healthy recovery and insurance pays what the doctor orders.
Your general physician or specialist and a conversation with Medicare will highlight what services will or won’t be covered.
Medicaid/Medi-Cal
Medicaid and Medi-Cal follow almost identical coverage guidelines as Medicare. The difference is that unlike Medicare, which is available to all adults 65 years old or more, regardless of financial stability, Medicaid and Medi-Cal provide additional healthcare for seniors living below a certain economic level.
If applicants qualify for Medicaid or Medi-Cal, the requirements for temporary or part-time home care support mimic that of Medicare. Part of these programs may include the ability for a spouse, child, or family caregiver to receive financial support for their role as caregiver. This also alleviates home care costs.
Medigap Insurance
Medigap insurance is a supplemental plan paid for out-of-pocket. While designed to help cover gaps in standard Medicare plans (co-payments, deductibles, and co-insurance), it does not cover home health services or items that are not covered by Medicare, such as hearing aids, routine vision care, and long-term care.
We recommend downloading the Medicare & Home Health Care guide for more details about Medicare, Medicaid/Medi-Cal, and Medigap insurance and what they do and do not cover regarding home health. You can also call their helpline at 1-800-MEDICARE (1-800-633-4227) for the most current information. TTY users can call 1-877-486-2048.
PACE Programs
PACE (Program of All-Inclusive Care for the Elderly) programs are another potential option. PACE is available in 30 states, including California. Qualification for PACE depends on your income. So, like Medicaid/Medi-Cal, most qualifying participants have some financial need.
The program relies on guidelines similar to Medicare and Medi-Cal when it comes to home care coverage, although individuals qualifying for PACE have a team of interdisciplinary medical and social services professionals overseeing their care.
This often provides the advantage of connecting clients/patients with home-care-oriented community services and support that might not be provided or advertised via Medicare/Medi-Cal.
Another benefit of PACE is that depending on an individual’s qualifications, it may cover co-payments and deductibles not covered by Medicare, in return for a minimal monthly premium.
Veteran’s Benefits
If your loved one was a veteran, look into VA benefits and pension offerings. The VA is dedicated to keeping veterans out of nursing homes and supporting home and community-based care through various programs. In some cases, the veteran’s pension may also be leveraged to pay for home care costs.
Private Health Insurance
As you can imagine, private health insurance coverage for home health is as varied as the number of policies available. In addition, most private insurance companies do not pay for non-medical home care services.
However, it’s always worth speaking to insurance representatives and the loved one’s physician to see how a combination of Medicare and private health insurance can be used in tandem, or back-to-back, to make home care as affordable as possible.
Long-Term and Life Insurance Policies
Does your loved one have long-term insurance or a life insurance policy? If so, call the representatives as soon as possible to learn more about policy terms. Many seniors are unaware they can take a loan back on the principal amount to reduce or cover in-home care costs.
What they initially took out to support loved ones in the case of a traumatic injury or death may be used instead to maintain their quality of life via high-quality in-home care.
Learn About the Many Options Available to Pay for In-Home Care
Do you feel that insurance coverage for in-home care isn’t enough? Don’t despair! Insurance is just the tip of the iceberg. Schedule an assessment with Families Choice Home Care to learn more about all the many ways clients creatively fund in-home care services without breaking the bank.
