Paying for Home Care

She's safe in the hands of her nurseHome care services may be covered a variety of sources and programs. However, benefits and eligibility requirements vary greatly, so it’s important to understand the terms of your coverage. You can pay for home care services on your own.  If you are unable to pay, many of our New Hampshire agencies are non-profit organizations that offer a sliding fee schedule and free care.

Major sources of payment for home care services –

* Medicare:  The individual must be under a physician’s plan of care, homebound, and in need of part time or intermittent skilled nursing care or occupational/physical/speech therapy. The agency providing the services must be a Medicare-certified agency. The range of covered services may include skilled nursing care, home heath aides, speech and occupational therapy, medical social services and medical supplies/equipment.

* Medicaid:  The New Hampshire Medicaid Program helps pay health care costs for all persons who receive public assistance and for certain persons with low incomes who can’t afford the cost of health care. It is based on federal and state rules and people must meet income and resource limits to qualify For people whose income is greater than the Medicaid limits but have medical bills they can’t afford, Medicaid may be able to assist them through the “In and Out Medicaid” program.

* Private Health Insurance:  Policy coverage differs greatly. Generally, private insurance coverage is limited to physician-directed medical services and equipment. Long term care insurance policies may include home health as well as nursing home coverage.  Be sure to check with your insurance company first to determine coverage specifics.

* Health Maintenance Organizations (HMOs) – HMOs and Comprehensive Medical Plans (CMP) with Medicare contracts must provide the full range of Medicare-covered services that are available in a geographic area, including home health care services.

* Private Pay:  Home care services can be paid by the individual or their family. The scope of services and the charges are negotiated between them and the agency. For those with limited resources, some home care agencies offer a sliding-fee schedule.

* Workers’ Compensation:  Any person needing home care services as a result of injury on the job is eligible. Workers’ compensation representatives have information on coverage.

* CHAMPUS/VA Benefits: On a cost-shared basis, skilled nursing care and other professional medical home care services are covered for dependents of active military personnel, retirees and their dependents and survivors.

Additional Information on Medicare and Home Care

Medicare-certified agencies are licensed home health agencies that comply with strict federal regulations and are authorized to provide a full array of skilled care services to Medicare beneficiaries. In order to have home health services covered by Medicare, patients must meet certain medical requirements. Medicare regulations and criteria frequently undergo changes. If you have specific questions regarding any aspect of Medicare home health eligibility and coverage, call your local home health provider.

Medicare Resources:
Centers for Medicare & Medicaid Home Health Services
Official Medicare Home Health Care Benefits booklet
CMS Find and compare Medicare-approved home health agencies
Information on Eligibility

New Hampshire Medicaid Information

New Hampshire Medicaid has several specialty programs to provide medical assistance to specific populations or individuals. Two such programs are the Home Care for Children with Severe Disabilities (formerly known as the “Katie Beckett” program) and Home and Community Based Care for the Elderly and Chronically Ill (HCBC-ECI), which is designed as an alternative to nursing facility care.

New Hampshire Resources:

New Hampshire Service Link
Medical Assistance Eligibility and Programs
Home and Community Care

Use the Find a Home Care Agency search function on the right side of this page for information on the agencies that deliver different types of home care in New Hampshire’s communities.