Insurance & Billing Help

What Insurance Usually Covers

• killed nursing (wound care, medication, monitoring)
• Physical, occupational, or speech therapy
• Home health aide (only if tied to skilled care)
• Medical social services

Not usually covered: 24/7 care, cooking, cleaning, or long-term personal care.

Types of Insurance

• Medicare – Covers skilled, part-time care with a doctor’s order.
• Medicaid – Coverage varies by state, sometimes includes more personal care.
• Private Insurance – Check your plan; benefits differ.
• Veterans/VA – Often has home health benefits for eligible veterans.

What You May Pay

• Deductible: Pay this before insurance starts.
• Copay/Coinsurance: Your share after deductible.
• Out-of-Pocket Maximum: The most you’ll pay in a year.

Billing Process

• Doctor gives order/referral
• Agency checks insurance
• Insurance approves (if needed)
• Care begins at home
• Agency bills insurance
• Insurance sends EOB (Explanation of Benefits)
• You may get a bill if something isn’t fully covered

Quick Tips

• Always ask your insurance what’s covered before starting care
• Keep your EOBs and statements
• Ask about payment plans if costs are high
• Appeal if a service is denied you have rights