Delivery is usually made via private pay, (i.e. by client/client’s representative), by private insurances or by a third-party payors. Medicare does not usually cover unskilled services except as authorized under certain conditions of home health. Generally, a physician’s order and plan of care is not required for Non-Medical services. The Client/\Client’s Representative and the Agency/Agency Representative jointly assess the client’s needs and develop a Care Plan and Service Agreement for meeting these needs. The usual practice is for Non-Medical Home Care Agencies to assume responsibilities for staff recruitment, screening, background checks, selection of candidate, definition of wages, task assignment, supervision, work schedules, back-up service, payroll, deduction and submission of payroll taxes Social Security, unemployment taxes and Workers Compensation, if applicable, and termination of service and/or employment.
Home Nursing services are also available through private pay, however commercial health insurance policies cover some Home and Home Nursing Services for acute needs, but benefits for long-term services may from differ plan to plan. Commercial insurers, such as Blue Cross and Blue Shield, generally pay for skilled professional Home Care Services with a cost-sharing provision. These policies sometimes cover personal care services. Most commercial and private insurance plans will cover comprehensive hospice services, including nursing, social work, therapies, personal care, medications, and medical supplies/equipment. Cost sharing varies with individual policies, but often is not required. If additional Home Care coverage is wanted, clients may need to purchase Medigap insurance or long-term care insurance policies.
Medigap is an insurance policy offered by private insurance companies to fill the “gaps” in coverage for original Medicare. The purpose of Medigap is to compensate for some of the shortfalls in Medicare coverage. Some Medigap policies offer benefits to facilitate at-home recovery, which pay for some personal care services when the policyholder is receiving Medicare-covered skilled home health services. The policyholder’s physician must order this personal care in conjunction with the skilled services. It is most beneficial to people recovering from an acute illness, an injury or from surgery. It is not meant for extended long-term care.
Initially, long-term care insurance was meant to help people with the costs of facility care. However, as the “needs” and “wants” for Home Care grew, these policies have been extended to cover personal care, companionship and other in-home services. These policies are quite diversified and the provider should check with their client to see if they have such a policy.