How Do Families Pay for Home Care in the St. Louis Area?
You have several options to pay for home care services. Some of your options are listed below. To discuss these and additional options, please call our office and request a call from a Care Manager today!
Pay for Home Care Privately
Also known as “private duty home care” or “hourly”, is usually paid for out of pocket directly by the client. Services are generally provided 2 to 24 hours daily as required. On a rare occasion, the term “private duty services” is used to describe services covered by some public funding sources, such a Medicaid for special needs clients. Amongst industry professionals, you may hear private duty or private services referred to as “custodial” services.
Long–Term Care Insurance
More and more people will pay for home care and private duty services with LTC insurance. Typically, you can utilize your LTC benefits when there are ADLs (Activities of Daily Living) that you are no longer able to perform.
Examples of ADLs include walking, toileting, dressing, and feeding oneself. If you or a family member has an LTC insurance policy and have questions about when you can tap into your benefits, please call us immediately.
Our Care Managers are very familiar with utilizing LTC benefits to pay for your needed care.
The Affordable Care Act has no provisions for providing coverage for private duty or custodial care. The best time to buy an LTC policy is between the ages of 30 to 55. The monthly premiums for LTC policies increase sharply in one's 60s. It is almost impossible to be eligible or to qualify for a reasonably priced policy in one's 70s and beyond.
Short-Term Home Care Insurance
A relatively new option to pay for home care services is short-term home care insurance. These policies, unlike long-term care insurance, generally have no waiting period before they kick-in to pay for care.
Most long-term care policies have a 90 day waiting period. For that reason, these plans are also known as "recovery care", because they can be used immediately after hospitalization to assist with paying for needed care.
Some of these plans only require your physician to confirm that assistance in the home is necessary, and not that you cannot perform a specific number of ADLs.
General Health Insurance
Generally, individual or employer health policies will ONLY pay for home care that is related directly or indirectly to rehabilitation services, such as physical, occupational or speech therapy.
This care is always on a limited visit basis and is usually VERY short term. We have RARELY found exceptions to that rule, BUT we have found them.
If you have an insurance policy that states that it provides “home care” or “home health care” coverage, we will gladly speak with the claims department prior to initiating service to clarify the parameters of coverage, at no charge to you.
We speak their lingo and know what questions to ask to make sure you are not out of pocket for services that you believed were being reimbursed or paid for by your insurance plan.
Most custodial care in the United States is paid for by Medicaid. Medicaid is a state-funded payer source that is partially funded by the federal government. Medicaid is for individuals that cannot afford to pay for home care services out of pocket. To be eligible for Medicaid you must meet strict financial parameters.
You will hear the custodial care provided through Medicaid also called “in-home” or “chore worker” services.
Our agency works closely with the State of Missouri in helping clients get authorization for these services. We have been a vendor of the State of Missouri for Medicaid since 1989, thereby making us one of the oldest providers of this service in the state. With advanced planning you can become eligible for future benefits.
Consumer Directed Services (CDS)
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Veterans Direct In-Home Care Services
If you are a Veteran, you and your spouse might be eligible for home care benefits under TWO different programs. The Veterans Administration Home and Community Based (HCB) OR the VeteransValourCARE. To learn more please CLICK HERE to visit our Veterans page.
Does Medicare Pay for Home Care?
Medicare is the federally funded health insurance available to individuals that are 65 or older. Medicare currently has no income eligibility parameters. Seniors choose to subsidize their federally provided Medicare coverage with private plans. Similar to general health insurance plans Medicare pays for “home health care” that is directly or indirectly related to the rehabilitation services listed earlier. Medicare home health services are also known as “intermittent’, “skilled”, or “rehab”. Seniors and their families are often disappointed and surprised to discover that Medicare does not pay for hourly private duty or custodial services.
Do Medicare Advantage Plans Pay for Home Care?
Medicare Advantage (MA) is one of the private plans that a senior can choose to augment their Medicare benefits. Since January 2019, Medicare Advantage plans have been federally authorized to provided custodial (hourly assistance by an aide) home assistance. This assistance is capped at 120 hours per year. As of late 2019, few MAs have moved to offer this added benefit. None are offering it in the Midwest as of late 2019. Over the next few years, we expect to see these offerings increase. Stay tuned!
Worker's Compensation Insurance
StaffLink has provided up to 24/7 home care services to several clients through the years who required licensed (RN and LPN) and non-licensed (aide) care due to a catastrophic injury at work. Past clients have included, police officers, construction workers and sports professionals. StaffLink has working relationships with local and national case management companies. We welcome calls from families, employers or case managers regarding our services in this area.
US Department of Labor Workers’ Compensation Program – Department of Energy
StaffLink is an approved provider of services with the US Department of Labor Workers’ Compensation Program (OWCP), specifically the Division of Energy Employees Occupational Illness Compensation Program (DEEOICP). StaffLink has the ability to provide home care services under this program if you are eligible. You may be eligible if you are, or have been, an employee, vendor, or contractor of the Department of Energy (DOE). If you have questions please contact us for more information.
The list above is NOT all-inclusive. There are numerous other payment sources offered by non-profit and public sources that can help cover the cost of care services in your home. Call the StaffLink office to talk to a professional about your individual situation.