Paying for Care from VNS Health
When a loved one needs home care or hospice care, you’ve got a lot to consider. Your mind is focused on other priorities — and the last thing you want to worry about is paying for care.
At VNS Health, we know that finances are a reality as you and your loved one navigate home care. That’s why we help you understand your options for paying for care. We’ll work with your family to determine your specific coverage and help you access the care that your loved one needs.
In most cases, Medicare, Medicaid, Veterans Affairs (VA) benefits, and private insurance cover home care and hospice care. In other cases, paying out of pocket is an option. We accept a variety of payment options and even offer health plans to some eligible New Yorkers.
Here are some options you can use when paying for home care from VNS Health.
Medicare
Medicare is a federally funded health insurance program, mostly for patients 65 and older.
When a doctor orders home care, Medicare may pay for services, including:
- Part-time nursing care
- Part-time home health aides
- Rehabilitation therapy (including speech, physical, and occupational therapies)
- Social services
- Medical supplies
Home care covered by Medicare needs to be part of the doctor’s orders. Medicare does not cover around-the-clock home care, meal delivery, or assistance with shopping or domestic chores.
Keep in mind — some services, equipment, and supplies may need prior approval before they can be covered.
Medicaid
Medicaid is a health insurance program funded by federal and state governments. It is available to United States citizens and permanent residents who meet certain requirements for income, resources, age, or disability.
In general, Medicaid covers most skilled nursing care — whether at home or in a facility — and personal care provided by a home health aide. It may also cover:
- Medicine
- Supplies
- Equipment
- Transportation to and from medical appointments
Like Medicare, Medicaid does not cover around-the-clock home care, meal delivery, or assistance with shopping or domestic chores. However, Medicaid does cover long-term care. Be aware that some services, equipment, and supplies may need prior approval before they can be covered.
Private Pay
Private pay (paying out of pocket) may be an option if your loved one wants more services than insurance will cover — such as round-the-clock nursing care or services provided by a home health aide. Caregivers who need additional assistance and support in caring for a family member who is receiving home care or hospice services may choose to pay out of pocket. Private-pay options are also available to those who just need help ensuring that their loved one can stay healthy and safe in their home.
Seniors and their families may choose paying for home care out-of-pocket because:
- It gives you greater flexibility when:
- Medicare or private insurance doesn’t pay for all of the services you need or want.
- Medicare or private insurance coverage has ended.
- Your medical needs do not qualify you for covered home care services.
- You can avoid the restrictions and limits placed on programs provided by the government or private insurers.
- Many people find that home care costs are typically much lower than fees at residential health care facilities, such as nursing homes and assisted living or memory care facilities. For instance, the average monthly cost of in-home care services in New York State is just under $5,000 — compared to over $12,000 for a nursing home facility.
If you are a VNS Health patient — or the caregiver of one — and you would like more services than Medicare or a private insurance company will cover, you can supplement the covered services by choosing to pay for private care while still maintaining care that is reimbursed by Medicare.
Our private-pay home care services include:
- Private nursing care
- Clinical assessments
- Companionship
- Caregiver support services
- Health care escorts
- Geriatric care management
- Senior care
- Care for Alzheimer’s and other dementias
Private Health Insurance
Private health insurance (such as from your employer or coverage you buy on your own) and long-term care insurance may cover some home care services (including skilled nursing care, rehabilitation therapy, or services provided by a home health aide). This may be an option for your loved one if they do not have Medicare or Medicaid or if they want more services than other programs cover.
Benefits for Veterans
If your loved one is a veteran, they may qualify for VA benefits. Made for veterans who need help with personal care and daily living, VA Homemaker and Home Health Aide Care is a program for veterans who are on their own or have caregivers but still need more support.
Homemaker and Home Health Aide Care can be used in combination with other home care services. The program serves veterans of any age and helps them remain in their own homes for care. VNS Health has veterans liaisons who can help veterans and their families identify benefits when paying for home care.
Paying for Hospice Care
Medicare, Medicaid, the VA, and most private insurance companies cover hospice care. Insurance starts as soon as you are admitted into the hospice program.
Keep in mind — VA benefits vary. In general, benefits for combat or wartime vets are not based on income. Eligibility or peacetime vets may be income-based. Vets must have received an honorable, other than honorable, or medical discharge to qualify. They usually must have been on active duty for at least 24 months.
In New York State, insurers are required by law to cover hospice care. But private insurance companies may limit benefits and coverage. If you have private insurance, check with your plan.