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Information about all aspects of finances affected by a serious health condition. Includes income sources such as work, investments, and private and government disability programs, and expenses such as medical bills, and how to deal with financial problems.
Information about all aspects of health care from choosing a doctor and treatment, staying safe in a hospital, to end of life care. Includes how to obtain, choose and maximize health insurance policies.
Answers to your practical questions such as how to travel safely despite your health condition, how to avoid getting infected by a pet, and what to say or not say to an insurance company.


The cost of home health care is generally less expensive than the cost of traditional healthcare treatment facilities, such as hospitals or nursing homes unless you require a great deal of nursing or other specialized professional care.

If you have health insurance

As more fully described in other sections of this article, private health insurance, Medicare, Medicaid, military insurance and long term care insurance generally cover home health care.

If your health doesn't cover home care, ask your doctor or a home care agency to negotiate with your insurer to obtain coverage for you. Before calling, the person who will call should have an understanding of what your insurance covers, as well as a detailed plan showing the cost savings to the insurer by allowing you to have care in your home compared to the cost of care in a setting that the insurance does cover.

If you do not have health insurance or your health insurance does not cover home care

If you do not have insurance and cannot afford care at home, there are alternatives to consider which are described in the other sections. 

If needed, you may be able to obtain medical equipment for use at home for free or at low cost. 

Other sections of this article cover the following subjects:


  • To get an idea of the current cost of different types of care in the state in which you live, go to offsite link
  • For information about maximizing use of a home health aide, click here.

How Do I Qualify For Home Health Services?

The following are some of the criteria that may be required to obtain home health care.

Your doctor must agree that you require home health care.

A prescription from your doctor is generally required to obtain professional services such as skilled nursing care, infusion services, and physical, rehabilitation and occupational therapies.

Supportive care services such as those provided by a home health aide or homemaker do not generally require a doctor's consent, although some of these services may not be covered by your insurance provider if not provided with your doctor's consent.

Your insurer may have requirements that must be met in order to provide coverage.

For example, Medicare / Medicaid requires that you be home bound and in need of skilled nursing services before coverage takes effect. Medicare and Medicaid also require that an agency be certified.

Managed care insurance plans may require that you use only agencies with which they are contracted to provide services. (To learn more, see: Types of Health Insurance Policies).

Home health agencies may have their own admission requirements

For example, some agencies only work with patients who reside in a specific area.

Agencies have the right to deny service if they feel that your medical condition requires complex medical treatments that they are not capable of providing.

Medical Equipment At Home

Health insurance that pays for home care generally pays for purchase or rental of the medical equipment necessary to allow you to stay at home.

If you have to pay for the equipment yourself, the cost may be a factor in determining whether home care is possible or whether you have to move into an assisted living facility, a nursing home or a hospital.

If insurance doesn't cover, you may be able to obtain the equipment for free through a local disease specific non-profit organization or a local community group.

When comparing costs to determine whether it is cheaper to rent or purchase equipment, include the cost of maintenance. Service may be included for free if you rent.

If you require infusions or other treatment that take time, find out if you can obtain a piece of equipment that allows you to move around while getting the treatment.

Private Health Insurance And Home Health Care

Most health insurance providers cover at least some cost of home care treatment because home health care is typically much less expensive than hospital treatment.

Coverage for acute (short term) medical needs are generally covered.Coverage for long-term care varies greatly from plan to plan. Check your plan or contact your benefits administrator for the specific details of coverage.

If home health care, or a specific home service is not covered by your plan, there is still a possibility of getting the company to pay. You, or someone acting on your behalf, may be able to convince your insurance provider to pay if you can show that the cost of home care will save the company money. Insurance companies are concerned about the high cost of medical care, and are increasingly willing to reimburse for optional services that can be demonstrated to be appropriate, cost-effective alternatives to hospitalization. The argument regarding cost effectiveness of home health care is generally an easy one to make.

Before contacting the insurer:

  • Get from your doctor in writing:
    • Confirmation that you need medical care in your home.
    • What services will be required.
    • What type of health care professional is needed to provide each service.
    • How often the services will be required.
  • Work with a health care agency to put together plan which will show how much it will cost the company per week or per month. The plan doesn't have to be to the penny, but should be within a reasonable range. Be sure that the costs are verifiable - for instance, that costs do not include cash payments for which there will not be any receipts.

When you call the insurer, speak with a supervisor or other person who has decision making authority.

Medicare And Home Health Care

The original fee-for-service Medicare plan pays for the costs of many home health care services. Home care may continue as long as your doctor indicates that it is medically necessary. 

In order for Medicare to pay:

  • Your doctor must:
    • Confirm that you need medical care in your home.
    • Determine what services will be required.
    • Decide what type of health care professional is needed to provide each service.
    • How often the services will be required.
  • You must need at least one of the following services:
    • Skilled nursing care
    • Physical therapy
    • Speech therapy
    • Occupational therapy
  • You must need the services, as Medicare says, on an "intermittent" (starting and stopping) and part time only basis.
  • You must be homebound. This means that you are normally unable to leave home and doing so is a major effort. Trips away from home must be infrequent and for a short period of time. Leaving home to receive medical care or to attend religious services is allowed.
  • The home health agency providing care must be Medicare approved.

A review is required at least every 60 days for care to continue.

Medicare covers the following services:

  • Skilled nursing services: Services that can only be performed safely by a licensed or registered nurse. Skilled nursing services must be needed on a part-time or intermittent basis (skilled nursing and home health aide services combined, are not to exceed 8 hours per day and 28 or fewer hours each week).
  • Home health aide services are designed to provide support care to the nurse. Services must only be required on a part-time or intermittent basis (home health aide and skilled nursing care services are not to exceed 8 hours per day and 28 or fewer hours each week). Only the agency supplying nursing care can provide home health aide services and be paid for by Medicare.
  • Physical Therapy services can continue as long as your doctor indicates they are necessary.
  • Speech Therapy services can continue as long as your doctor indicates they are necessary.
  • Occupational Therapy services can continue as long as your doctor indicates they are necessary.
  • Medical Social Services.
  • Medical Supplies.
  • Medical equipment is covered at 80% of the Medicare approved charge. Patients are responsible for the remaining 20%. Some companies will waive the 20% payment when requested, particularly if a patient is experiencing financial hardship. This is known as "accepting assignment."

Original fee-for-service Medicare does not pay for the following services:

  • 24-hour care.
  • Prescription drugs. Prescription drugs can be covered by Medicare Part D.
  • Meals delivered to your home. Medicare may pay for some nutritional supplements when medically necessary.
  • Homemaker services such as shopping, cleaning, and laundry.
  • Home Health Aide services when skilled nursing care is not required.

For additional information call 800-MEDICARE or visit offsite link

Medicare Advantage (Medicare Managed Care Plans): If you belong to a Medicare managed care plan, you may only receive care from a home health agency that is contracted to work with the managed care plan. If you receive services from a doctor or home health care agency that doesn't work with the managed care plan, neither the plan nor Medicare will pay the bill.

The qualifying criteria, and services provided, for home health care vary by insurer. However, they are generally similar to those provided by the original Medicare plan as described above. Review your plan or call your insurer to confirm participating home health agencies, and to receive specific plan information.

If you are told that your plan does not cover home care, or the home care you need, check with Medicare to find out if such care is a Medicare requirement even if it not stated in your policy. You can contact Medicare at 800.MEDICARE (800.633.4227)

Medicaid And Home Health Care

Medicaid provides home care coverage for individuals and home care agencies that meet the same qualifications required to obtain Original Fee-For-Service Medicare.

Federal regulations require coverage for at least the following services:

  • Intermittent (occurring at irregular intervals) and part-time nursing care
  • Intermittent and part-time home care aide services
  • Medical supplies
  • Medical equipment

Additional covered services vary from state to state, but may include:

  • Physical therapy
  • Occupational therapy
  • Speech therapy
  • Medical social services

To determine the exact services covered in your state, contact your State Medicaid office. You can find contact information for your state's Medicaid office(s) offsite link

Long Term Care Insurance And Home Health Care

Some long-term care insurance policies cover personal care, home attendant, and additional in-home services.

Check your policy carefully. Many long term care insurance policies have restrictions such as a pre-existing condition exclusion and a requirement that you must be in a hospital before you can receive covered long-term care.


Military Benefits And Home Health Care

Champus / Tricare: Home health care coverage is provided for all military personnel and their dependents through this program. Services include skilled nursing care, and other professional medical home care services. These services are provided on a cost-share basis. For more information see offsite link

Veterans Administration (VA): To qualify for home care, veterans must be at least 50% disabled as the result of a service related condition. All provided services require the consent of a doctor, and treatment must be provided through the VA's network of hospital-based home care units. These services are generally provided on a no cost basis for people who qualify.

  • Veteran-Directed Home and Community Based Services program.  In some communities, veterans who need assistance with daily living activities can enrll in the Veteran-Directed Home and Community Based Services program. The program provides money which can be used to pay family members for home caregiving. For information, see: offsite link
  • If you are a wartime veteran, Aid and Attendance helps pay for in home care. 

Older People And Home Health Care

The Older Americans Act 

The Older Americans Act provides federal funds for state and local social service programs that may enable older disabled individuals to receive care in their home. Individuals must be at least 60 years of age, and in great social and financial need. Funding may cover services such as home care aides, meal delivery, and shopping / errand provisions.

Requests for services can be made through an Area Agency on Aging, which may provide the services directly, or refer you to the proper sources. See the Homecare Resource Section to locate the agency nearest you. You can also see the Administration on Aging state contacts at offsite link.  Click on Find Local Programs. Or call the Eldercare Locator at 800.677.1116.


PACE is an optional benefit under both Medicare and Medicaid that focuses entirely on older people, who are frail enough to meet their State's standards for nursing home care. It features comprehensive medical and social services that can be provided at an adult day health center, home, and/or inpatient facilities. For most patients, the comprehensive service package permits them to continue living at home while receiving services, rather than be institutionalized. A team of doctors, nurses and other health professionals assess participant needs, develop care plans, and deliver all services which are integrated into a complete health care plan. PACE is available only in States which have chosen to offer PACE under Medicaid.

Eligible individuals who wish to participate must voluntarily enroll. PACE enrollees also must: be at least 55 years of age, live in the PACE service area, be screened by a team of doctors, nurses, and other health professionals as meeting that state's nursing facility level of care, and at the time of enrollment, be able to safely live in a community setting.

To find out if there is a PACE organization in your area, go to offsite link







Community Resources To Help Pay For Home Health Care

Various community organizations, as well as state and local government programs, may be able to provide funds for home health and support care services.

Eligibility is dependent upon need and financial situation.

Some organizations pay for all or a portion of services. Sources of information about community resources include: social workers, hospital discharge planners, Area Agency on Aging, and the United Way. To locate your local Area Agency On Aging, see offsite link.  Click on Find Local Programs. Or call the Eldercare Locator at 800.677.1116.

Also look to find out if there is a PACE organization in your area. You can find a PACE organization

Paying For Home Health Care Yourself

Arrangements can be made to pay for services out-of-pocket.

If you have insufficient or no insurance coverage and have limited or no financial resources, you may be able to negotiate fees with a home health agency.

Some home health agencies will provide limited services free of charge.

If you need a loan from a friend or relative, learn how to ask in a way that doesn't disrupt the relationship. For information, click here

Also consider: How To Raise Money From Friends, Family and Community.