Before you leave the hospital, be sure your discharge planner has reviewed your insurance coverage with you and your caregiver. It is very important that you know exactly what your health insurance will and will not cover. You will need to know what level of coverage your insurance provides for:
- A stay in a nursing home
- Visits to a rehab facility
- Home health aides
- Durable medical equipment
- Ambulance transportation
Be sure to find out how long your insurance will cover a specific type of care, like those listed above. Try to maintain contact with the same person at your insurance company each time you call or write. You may be assigned a case manager who will understand your condition and should eliminate the need for repeated explanations each time you call. Most importantly, keep detailed records of phone conversations and personal contacts at the company. Write down the time and date, the person you spoke with and details about the conversation.
Don’t be surprised if you find that many services and items you need for home care are not covered by your insurance. Unless you have separate long-term care insurance, many home-care services, such as those of aides or attendants, will be covered for only a short time or not at all.
Medicare--What You Need to Know
If you are eligible for Medicare, some of your after-hospital care may be covered.
Medicare Part A: covers some home healthcare and skilled nursing facility care. You must meet certain conditions.
Services that may be included in home healthcare coverage are:
Part-time skilled nursing care
Physical therapy, occupational therapy, speech-language therapy
Home health aide services
Medical social services
Durable medical equipment (such as wheelchairs, hospital beds, oxygen, and walkers)
- Medical supplies
Medicare Part B: helps cover your doctors’ services, outpatient hospital care, and some other medical services that Part A does not cover, such as some of the services of physical and occupational therapists, and some home healthcare. Part B helps pay for these covered services and supplies when they are medically necessary. You pay the Medicare Part B premium. For more detailed information about Medicare coverage and exclusions, visit Medicare.gov.
If You Disagree
If you are a Medicare patient and feel that you are being discharged too soon, you have the right to ask for a review from a Quality Improvement Organization (QIP). Call 1-800-MEDICARE (1-800-633-4227) for the number of the QIP in your state.
If You Are Uninsured
It can be financially challenging to pay for home healthcare services, medical equipment, prescriptions, and/or long-term care. Medicare and Medicaid pay for only some of your costs, and if you don’t have private insurance to cover the remainder, you need to know what your options are. Start with your local Area Agency on Aging. They can give you information on resources in your community. To find the agency near you, call the national Eldercare Locator at 1-800-677-1116.
Other good sources of eldercare information are:
The American Association of Homes and Services for the Aging
AAHSA.org
202-783-2242
The Assisted Living Federation of America
ALFA.org
703-691-8100
The American Health Care Association
202-842-4444