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Home Care

Private Health Insurance & Home Care

Reviewed by: MySeniorCare Staff
Last Updated: 4/13/2010 10:14:08 AM

According to recent studies, up to 40 percent of Americans between 18 and 64 need some kind of home care. One of the main problems those who purchase home care insurance face is finding a policy affordable enough to keep as the years pass.

Shopping For Private Health Insurance

When seniors or their caregivers shop for a health insurance policy, it's important to carefully review the terms because policies vary greatly in what they provide. Some pay for nearly all the costs of home health care, while others cover a small percentage. It's also possible to buy supplemental policies that pay for excess charges the patient's original insurance won't cover, such as home medical equipment.

Fifteen years ago, it was common to purchase home health care coverage separately from a long-term care policy. According to the National Association for Home Care, the current trend is for long-term care insurance to cover some personal care, companionship and other services in the home. However, many of these private policies have limitations on coverage, such as prior hospitalization requirements, exclusions for pre-exiting conditions and paying only for services already covered by Medicare.

What Private Health Insurance Pays For

Private health insurance policies generally pay for some home care services for acute needs. Many of the larger carriers cover services of skilled professionals, but only on a cost-sharing basis. While personal care is occasionally covered, most plans pay for comprehensive hospice services, to include nursing, therapies, personal care, medications, social work, medical supplies and some equipment. Caregivers might find it necessary to look into Medigap insurance or long-term care policies for additional coverage for home care services.

Seniors covered by managed care organizations (MCOs) often have coverage for some home care services. If an MCO has a contract with Medicare, it must furnish the full range of Medicare-covered home health care services that are available in a specific geographic region.

Health Insurance To Aid Caregivers

Caregivers - particularly those who are family members - often initially believe they can manage a senior's high-tech at-home care all by themselves. However, all too often, they burn out just as they realize they can't handle all the medical and personal care themselves.

There are three areas where caregivers usually need the most help:

In-home nursing and therapy. Many private health insurance policies will pay at least part of the cost of registered and licensed practical nurses when prescribed by a physician. Typical services they provide include monitoring medications and instructing patients and caregivers about special procedures. Private insurance often also at least partially covers the services of respiratory, physical, speech and occupational therapists in the home.

Home health aides. Some policies also cover the services of individuals who help with personal care like bathing, dressing, exercising and eating. However, most policies will not pay for these services when performed by a family member.

Hospice care. Coverage typically includes hospice care at home or in other settings. The services covered usually include pain and symptom management, social services and emotional and spiritual support for patients who are diagnosed as terminally ill.

If the senior is not completely homebound and is able to attend activities at an adult day center, some private health insurance policies now cover these services.

Seldom does private insurance pay 100 percent of any home care services. Caregivers and seniors should be sure to review all the details in several prospective policies before making a final decision as to which is the best buy.

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