We often get questions from physicians and providers about insurance coverage for home health care. Download a print-ready PDF of this information here.

MEDICARE PAYS 100% if certain criteria are met

Patients must

  • Be homebound
  • Need care that requires the skills of a licensed nurse or therapist
  • Require care that is part-time and intermittent
  • Require care that is reasonable & necessary for the diagnosis or treatment of a medical condition
  • Have a plan of care signed by their physician
  • Have an appointment with their physician within 90 days before or 30 days after the start
    of home health care for reasons related to the need for home health care.

Note: Medicare payment for Home Health Care covers reasonable and necessary supplies, including ostomy supplies, and outpatient therapy when it is reasonable and necessary to use equipment that is too cumbersome to bring into the home. While Medicare is paying for a patient’s home health services, the patient must obtain any needed ostomy supplies or outpatient therapy through CVHHH. No ostomy supplier or outpatient therapy provider can receive payment from Medicare while the patient is receiving home health care and the supplier can hold the patient responsible for the charges.

MEDICAID PAYS 100% if certain criteria are met

The services must

  • Be medically necessary, and
    • Appropriate to the diagnosis or condition
    • Consistent with generally accepted practice standards
    • Needed to help restore health, prevent deterioration or address symptoms
  • Address either an episode of acute illness or injury or a chronic condition.
  • Be ordered and furnished under a written plan, signed by the attending physician.

COMMERCIAL INSURANCE

(most will cover home health care)

Each individual policy is checked by the agency as soon as possible after the referral is received.

A printout listing the individual policy requirements is provided. We ask patients to check their individual policies correctly to determine what the policy pays and what the patient must pay. There may be:

  • Co-payments and / or deductibles
  • Limitations on number of visits
  • Prior authorization requirements