Kenyon HomeCare ConsultingBenefits of Private Insurance Contracting: Non-Medicare vs Medicare Home Health - Kenyon HomeCare Consulting (206) 721-5091

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Benefits of Private Insurance Contracting: Non-Medicare vs Medicare Home Health

Question MarkAs a home health agency, one of your most important jobs is helping clients figure out the right payment options. While you want to provide the best care possible, you also need to be properly reimbursed for your services. This article will discuss three reimbursement options: private health insurance, Medicare, and long-term care insurance.

Private Health Insurance

Many of your clients may assume that the health insurance plans they’re currently enrolled in through their employers will cover any services required if they were to become homebound. However, that’s not necessarily the case. Private health insurance will pay for some home health services, but not all – and only for a limited period of time. Here’s what your clients can expect from their private insurance plans:

  • Coverage for skilled nursing services
  • Available coverage only for short-term, medically necessary services
  • Limited or no coverage for personal care services
  • Varying premium costs based on individual policies
  • Possible deductible, coinsurance, or copay responsibility.

If you have clients who require home care due to illness or a temporary condition, and they don’t meet Medicare’s requirements, then need to research what their private health insurance will cover. Clients need to consider their total out-of-pocket costs, and you should discuss with them all the services you’ll provide in order to avoid any surprise expenses.


Anyone 65 or older is eligible for Original Medicare. Like private health insurance, Medicare will only cover certain home health services. Medicare will pay for qualified skilled services when the client is homebound and services are ordered by a physician. A multitude of personal or homemaker services are not covered by Medicare. Here’s what your clients need to know about Medicare and home health:

  • Services NOT covered include:
    • 24/7 in-home care
    • Meal delivery
    • Personal care
    • Homemaker activities
  • Only part-time, intermittent care is allowed
  • Skilled nursing, physical therapy, speech-language pathology, and continued occupational therapy are covered if ordered by a physician
  • Services must be deemed medically necessary
  • Home care agency providing services must be Medicare-certified
  • No copays for Medicare-approved services

Medicare is a good option for older adults who only need temporary care, like following a hospitalization and who are able to manage most daily activities independently.

If more care is needed and a client has Medicare, he or she can choose to purchase a supplemental health insurance plan – called Medigap – to help fill in the coverage gaps. This is something that, unlike Medicare, the client will need to pay for, both through a monthly premium and through copays or coinsurance. They should also keep in mind that Medigap plans are designed to allow for superior temporary care; they still won’t allow for long-term care.

Long-term Care Insurance

For those clients who suffer from chronic illnesses, can no longer function on their own, or simply need more help than either of the above options provide, long-term care insurance is the way to go. Through this type of policy, your client can feel confident they will receive the care they need without worrying about cost, and you can rest assured that you’ll be reimbursed appropriately.

Long-term care insurance is designed to pay for in-home medical services, as well as personal care (such as bathing) and homemaker activities (like meal preparation). While clients are required to purchase these plans, there are a variety of options that can be catered to meet individual needs.

No matter how you’re reimbursed for the care you provide, Kenyon Homecare Consulting can help you manage it. We offer ICD-9 coding and other services to help you increase your reimbursement percentages. Contact us today for more information!

Category: Accreditation & Licensing, Finances, ICD Coding

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