How is Care Paid For?

There are several ways to pay for non-medical, in-home care services. However, the vast majority of care is paid from the savings and resources of the individual receiving care or from their family. This is type of payment is commonly referred to as private pay or out-of pocket payment.

Some state and local programs exist for low income seniors but are limited and usually cover only short-term home care needs. Medicare does not cover non-medical care except when certain custodial services are part of an authorized medical home care episode and, of course, the person is Medicare eligible. Long Term Insurance (LTC) carriers currently pay for about 20% of the care in the country. LTC companies generally pay a fixed benefit per day and have a maximum benefit limit they will pay for in-home care given certain necessary requirements are satisfied. Many agencies will assist you in complying with the requirements of your LTC carrier. These may include verification of policy benefits, performing a pre-evaluation, obtaining a doctor's order, completing daily care notes and billing you for service rendered. It is generally your responsibility to pay the agency and to submit the bills to your LTC insurance carrier for payment on your policy. Some agencies do accept assignment of benefits, meaning they do all the paperwork and get paid directly by your LTC carrier.

The payment rates, terms and programs of in-home care agencies vary. However, their rates are generally priced on either an hourly, per day, or per shift including a 'live-in' basis. Some determine their charges based on the level of care needed, while others charge a flat rate per hour or day regardless of the care needed. Paying an upfront deposit is common in the industry. Agencies usually bill twice each month or on a monthly cycle. Payment by check is the most common form of payment although many agencies are set up for automatic debit payment. Fewer accept major credit cards because of the high fees associated with this form of payment.

As private payment is the most common form of payment within the industry, any agency will be able to fully describe their payment requirements when asked.

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