Self Pay
Other than short-term skilled nursing or therapy services that are part of a doctor’s authorized plan of care, most home health services are self paid by the senior or their family.

Depending upon the type and frequency of the services required, costs may range from hundreds to thousands of dollars per month. In most cases, they are still less than the cost of nursing home care.

All costs are included in your service agreement so that there are no surprises or unexpected charges. You know in advance exactly the care that will be delivered, who will be delivering it, and what it will cost. Seniors on fixed incomes don’t like and often cannot afford unexpected fees. With Advantage, it’s all transparent and upfront.

At Advantage, we work with you to build a service plan you can afford, and match our billing schedule to your needs, whether you intend to pay by cash or major credit card.

Most non-skilled home care services are paid privately by the individual or their family. Home care charges can be billed weekly or monthly. Payments can be made by cash or credit card (the preferred method). Monthly care management services (Advantage Healthwatch) are billed monthly.

If you have purchased long-term care insurance, you should consult your policy for details on coverage. Covered services vary widely from plan to plan.

Generally, long-term care insurance pays for daily assistance with personal care, etc. It also assists with assisted living and nursing home charges.

Your local insurance representative can refer you to specific plan providers for long-term care insurance.

The truth is that Medicare only covers care that your doctor prescribes, and is provided only for a temporary period, not long-term. Help required due to frailty, decrease in motor skills or cognitive ability, and other complexities associated with aging or chronic illness is not generally covered by Medicare.

Skilled services refer to services provided by licensed personnel (nurses and therapists).

Non-skilled or custodial services do not require a licensed individual and can be provided by a trained aide, companion or homemaker.

There are quite specific eligibility requirements for Medicare coverage:

• 1) Your doctor must document that you need care at home and oversees a formal plan for that care designed by the entity providing the services.
• 2) You must need skilled nursing care or require physical, speech or occupational therapy.
• 3) You must be homebound. What does that mean? In general terms, it means that leaving home without help is physically difficult or impossible for you.

If eligible, what will Medicare pay for?

• - Intermittent skilled nursing care delivered by either a registered or a licensed practical nurse. Medication teaching, disease management, injections, tube feedings, catheter changes, observation, assessment, management and evaluation of a patient’s care plan, and wound care are examples of skilled nursing care that Medicare may cover.
• - Licensed Physical Therapist services to regain movement and strength as well as training on the use of any special equipment required to aid in your recovery.
• - Licensed Occupational Therapist services to help you regain and maintain the skills required for daily activities such as feeding yourself, dressing or grooming, or upper body training or re-education, i.e., after shoulder surgery.
• - Licensed Speech-language Therapist services if you should need assistance in relearning to speak easily and clearly, or if you have swallowing difficulties.
• - Medical social services: These services can help you with social and emotional concerns related to your illness. For example, you might need counseling or help finding resources in your community.
• - Some Medical Supplies, including such items as wound dressings and catheters, as well as required equipment such as walkers, canes or wheelchairs (though there is usually a 20% patient co-pay). Prescription drugs are not typically covered by Medicare, except through Medicare Advantage plans.

Medicare will pay for personal care services if you are also receiving skilled care such as nursing care or therapy services. Each case is unique, but in general, if you only require assistance with bathing or dressing, Medicare will not cover such services without an identified skilled need.

Medicaid is a joint federal and state managed program designed for lower income individuals. Medicaid may cover limited skilled home care and often unskilled personal and homemaker services depending on each situation. There are specific income requirements for Medicaid. Interested seniors should contact their local Department of Children and Families to find out the process for obtaining Medicaid.

In the local Advantage services area in Central Florida, local chapters of some disease-oriented organizations like Multiple Sclerosis Society, Alzheimer's Association or charities like United Way sometimes assist with home care funding.