Expert Tips from our Members

Home Health Care Services De-mystified

What is Home Health Care?

Home Health Care is a service usually prescribed for homebound patients, by your primary physician. These services are delivered through a licensed home care agency, the delivery of which is state-mandated to be supervised by a Registered Nurse. The doctor recommending the service will draw up a plan of care for the patient and yardstick by which the administration of such service is measured, for the duration of the service.

Covered Services

Eligible Home Health Care services include:

(a) Intermittent skilled nursing care,

(b) Physical therapy,

(c ) Occupational therapy and

(d) Speech therapy

(e) Medical Social Services

(f) Certified home Health aides

(g) Medical supplies for use at home

(h) Durable Medical equipment

(i) Injectable osteoporosis drugs

Home Healthcare services are covered under Medicare Part A (Hospitalization Insurance) and Medicare Part B (Medical Insurance) and is usually coordinated and delivered through a licensed home health care agency. If you are not covered under Medicare, these services are most likely covered through your States Medicaid Managed Long Term Care Program. Otherwise if you require homecare services and are not Medicare/Medicaid eligible, you will have to pay privately (i.e. out-of-pocket or through your commercial insurance plan). Often, individuals are not aware that the insurance plan they own, and have paid into for years, do have some provision for their long term care needs. If unsure of what is covered under your plan, have your agency check your eligibility with your insurance company.

If you are in an adult day care facility you may still be eligible for homecare services.

Uncovered Services

Sometimes a doctor may recommend a patient for home health care services, but may include services that are not covered by Medicare. When this happens the patient may have to pay out-of-pocket for some or all of the costs. Other services not covered by Medicare are:

a) Personal care

b) Home-making services

c) Meals

d) 24-hour skilled nursing care

How can I get Care at Home?

If you are a Medicare beneficiary, you may be eligible to receive home health care benefits. To be eligible under Medicare the following conditions must apply:

1) Your doctor must have recommended the service for you at home, and have prepared a plan of care.

2) You must be recommended for at least one of the services described above

3) You must be homebound. When you do leave home it must be infrequent and for short periods of time, or for medical care.

4) The agency providing service must be licensed by the state and certified by Medicare.

If you are Medicaid beneficiary you will need to determine eligibility and coordinate service through one of the four insurance companies that manage the Long Term Care Program in New Jersey. These companies are:

1) Horizon of New Jersey

2) Healthfirst

3) United Healthcare

4) Amerigroup

If you require homecare services and is prepared to pay privately (no medicare/medicaid) you will work through your agency to coordinate and pay for services.

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