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Medicare is a national health insurance program provided by the federal government. It covers people age 65 or older and people of all ages with certain disabilities or end-stage renal disease. To receive Medicare coverage for home health, you must meet all four of the following criteria:

• A doctor must determine that medical care in your home is necessary and make a home health care plan for you accordingly.
• You must also need at least one of the following services:
  • Intermittent (part-time) skilled nursing care
  • Physical or speech therapy
  • Continued occupational therapy
• You must also be homebound.
• The home health agency caring for you must also be approved by the Medicare program. Approved agencies like Visiting Nurse Association are typically referred to as “Medicare certified agencies.”

If you or your loved one receive Medicare benefits and meet all four criteria, Medicare will cover:

• Skilled nursing on a part-time basis, as long as your home health care provider is a registered or licensed practical nurse.
• Rehabilitation therapy, if ordered by your doctor.
• Home health aide services on a part-time basis. Medicare will only cover home health aide services if you are also getting skilled care like nursing or other therapy.
• Medical social work services to assist with social and emotional concerns related to your illness, injury or condition.
• Certain medical supplies, such as wound dressings.

Medicare does not pay for:

• 24-hour per day care in the home
• Meals delivered to the home
• Homemaker services (such as cleaning, laundry, shopping, etc.)

If you need home health care, our billing specialists can assist with determining Medicare coverage for your individual needs. Please call 816-627-6210.

To learn more about Medicare in general, call 1-800-MEDICARE or visit medicare.gov.

Medicaid is a federal and state program that pays for certain health care services provided to low-income patients, including home health. It is up to each state to determine its own requirements and coverage. To qualify for Medicaid, beneficiaries must have low-incomes, little savings and no other substantial assets, as defined by the state.

All states allow Medicaid to pay for basic home health care, which includes:

• Skilled nursing (part-time)
• Home health aide services
• Medical supplies and equipment

Medicaid may pay for homemaker and other services not paid for by Medicare. Additional coverage and patient eligibility requirements vary by state:

Kansas Medicaid

In Kansas, Medicaid also covers home health rehabilitation therapy services. The state of Kansas does not require patients to be homebound to qualify for home health coverage, but prior authorization for home health services may be required.

Missouri Medicaid

Missouri Medicaid only pays for rehabilitation therapy services if the Medicaid benefits are due to blindness. To qualify for home health coverage from Missouri Medicaid, the patient must be homebound.

If you need home health care, our billing specialists can assist with determining Medicaid coverage for your individual needs. Please call 816-627-6210.

You can also obtain more information about Medicaid coverage for home health care by contacting your state’s medical assistance office:

• Kansas: 913-826-7300 (Johnson County) or visit the Kansas Department of Social and Rehabilitation Services online.
• Missouri: 1-800-392-2161 or visit the Missouri Department of Social Services online.

In most cases, private insurance covers a portion of home health services for acute (short-term) needs. Patients are typically responsible for making partial payments via co-pays and/or deductibles. Most insurance plans require that your doctor determines a need for medical care in your home and develops a plan of care.

There are several different types of plans that cover home health care:

• Health Maintenance Organizations (HMOs)
• Preferred Provider Organizations (PPOs)
• Indemnity plans
• Medicare Advantage (MA+) plans *

Eligibility criteria for many private insurance plans are similar to Medicare guidelines. To find out if Visiting Nurse Association (VNA Home Health) accepts your insurance plan, call our billing specialists at 816-627-6210 or contact us online. We will be happy to determine your plan’s home health qualification guidelines and coverage for home health care by contacting your carrier. You may also find it helpful to contact your insurance provider’s member services directly.

* MA+ plans must provide coverage for all the same services as Medicare, but restrictions may vary.

There may be times when home health care is not covered by third party payers, and you or loved ones pay out-of-pocket instead. Typically this occurs under one or more of the following circumstances:

• Patient benefits are exhausted
• Insurance plan no longer covers the necessary home health services
• Patient no longer qualifies for federal or state financial assistance
• Patient no longer meets the payer’s criteria to receive home health care

Whatever the reason, sometimes patients and their families must pay for home health services privately (out-of-pocket); for some others, private individual pay is preferred. By avoiding care limitations imposed by government programs and private insurance plans, individual pay enables more flexibility in the type, duration and amount of services provided for the patient.

Individuals who pay privately out-of-pocket may purchase home health services from Visiting Nurse Association (VNA Home Health) by the visit. Call 816-531-1200 for more information.