Medicare, Medicaid, or Private Pay?

We will try to, briefly, explain each type of coverage.  For more information please call us at (325) 655-6600.

Medicare

Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance) covers eligible home health services like intermittent skilled nursing care, physical therapy, speech-language pathology services, continued occupational services, and more. A home health care agency coordinates the services your doctor orders for you.

Your costs in Original Medicare

  • $0 for home health care services.

Medicare doesn’t pay for:

  • 24-hour-a-day care at home
  • Meals delivered to your home

Before you start getting your home health care, the home health agency should tell you how much Medicare will pay. The agency should also tell you if any items or services they give you aren’t covered by Medicare, and how much you’ll have to pay for them. This should be explained by both talking with you and in writing. The home health agency should give you a notice called the “Home Health Advance Beneficiary Notice” (HHABN) before giving you services and supplies that Medicare doesn’t cover. More often than not, there are no additional charges for patients who are covered by Medicare.

Medicaid

Fewer and fewer providers are accepting Medicaid due to the low reimbursement levels. It has become very difficult for agencies to accept Medicaid. San Angelo Home Health does NOT accept Medicaid at this time. If you have had difficulty finding a provider who accepts Medicaid, please contact our office for assistance in finding one who can help you.

Private Pay

“Private Pay” is the term used to identify those patients whose costs are NOT covered by a government program, such as Medicare or Medicaid.  Private pay can mean a person is paying for services themselves (private pay), or it can mean that a patient has commercial insurance and is having to cover some of the costs themselves (out-of-pocket). The costs for home health care vary significantly depending on the type of insurance you have. Your benefits will be verified prior to a home health admission and details of charges will be provided to you, in writing. Be sure to understand what your “out-of-pocket” costs might be by consulting your insurance company prior to admission.

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