Who Pays

Who Pays for Home Care?

Home Care is paid for by a variety of sources. Benefits and requirements vary greatly. Major home care payment sources include:

• Patient/Private Pay Home care services can be personally paid. The scope of services and the charges are negotiated between the patient/family and the agency. For those whose resources do not cover home care, some home care agencies offer a sliding-scale fee schedule so that a family need only pay what it can afford.
• Private Health Insurance including Health Maintenance Organizations (HMOs) Policy coverage varies. Generally, private insurance coverage is limited to physician-directed medical services and equipment. The patient and family should check with their insurance agent to determine coverage specifics.
• Medicare The patient 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. Medicare beneficiaries may receive a range of services which include skilled nursing, home care aide, speech and occupational therapy, medical social work and medical supplies/equipment.
• Medicaid (Medi-Cal in California) This federal/state administered medical assistance program provides services similar to Medicare for low-income people. No prior hospitalization or "skilled" level of service is required to qualify. Individuals do not need to be homebound.
• Workers' Compensation Any person needing home care services as a result of an injury on the job is eligible. Workers' compensation representatives have information on eligibility.
• CHAMPUS On a cost-shared basis this program covers skilled nursing care and other professional medical home care for dependents of active military personnel, retirees and their dependents and survivors.