What are Home Care Services? The Basics of Everything: Home Care, Insurance, and More

You may someone new to the world of home care.  It can be confusing with the terminology that is used such as a caregiver or certified home health aide.  They use terms such as Medicare and Medicaid. You may ask yourself what is home care?  Why is it a big deal?  What can it do for me?  I am here to answer your questions.

Home Care in a Nutshell

Home care is professional caregiving that is provided in patients home.  The personal caregiving is usually performed by a trained Certified Home Health Aide.  A Certified Home Health Aide is a personal caregiver to people who need assistance in their day-to-day activities due to a medical condition, prolonged illness, physical impairment, cognitive impairment, or old age.  The role of a Certified Home Health Adie may differ depending on the patient’s medical condition and/or specific needs.  Additionally, Home Health Aides may assist patients with routine tasks such as: 

  1. Doctor appointments
  2. Bill payments
  3. Grocery shopping
  4. Picking up medication for their care
  5. Taking blood pressure
  6. Monitoring their health on a day by day basis

Medicare, Medicaid, and Health Insurances 101

The terminology for the home care consists of Medicare, Medicaid, and Private Pay.  The difference between Medicare and Medicaid is that Medicare is a federal program attached to Social Security.  It is available to U.S citizens 65 years of age or older, and it also covers people with certain disabilities.  It is available regardless of income.

Medicaid is a joint federal and state program that helps low-income individuals and families pay for the costs associated with medical or long-term custodial care.  It is a public health insurance plan available.  For instance, if your income is between 100% to 400% below the poverty line, you qualify for Medicaid.

Health insurance is a product that covers medical expenses.  However, health insurance doesn’t always cover 100% of your costs.  In fact, it’s designed to share costs with you up until a certain point called the out-of-pocket limit.  If you hit the the-out-of pocket limit, the health insurance will help pay for the 100% of health costs.

Normally, these costs include a deductible and/or copayment.  This is how health insurances share costs with you.  Furthermore, all insurance plans are required to cover ten essential benefits. Then there is a separation between the Preferred Provider Organization (PPO) and Point of Service Plan (POS).  PPO plans provide a network of doctors and/or hospitals that provide a lower rate.  They do not require you to receive a referral from your doctor to see a specialist.

HMO or Health Maintenance Organization plans give you access to certain doctors and hospitals within the network.  A network is made up of providers that have agreed to lower their rate for plan members and also meet quality standards.

Point of Service (POS) plan is a hybrid of HMO and PPO plans.  You will have a primary care provider and you can see doctors within the network or out of network.

Private Pay 

You might be thinking that you need insurance to receive home care services.  This is not the case.  Home care services, like other medical facilities, provide the option to pay out-of-pocket.  Typically, home care agencies create customized care plans to meet clients needs.  If individuals do not want to go through their insurances, it may be cheaper to pay privately for the services instead. They offer flexible payment plans too.

What To Do Next?

With basic knowledge on how home care agencies and insurance companies work, your next move would be to determine if you have a loved one who could benefit with an extra set of hands.  Personal care is met with trained, certified, and committed standards for the patient-centered care.

 

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