Who Pays for Home Health? Medicare vs. Private Pay

One of the questions people often ask about receiving home health care is who pays for the service. If you’re an older or disabled person covered by Medicare, you may wonder how much Medicare covers, and at what point private pay kicks in.

Here’s how it all works after a patient is hospitalized.

Medicare’s coverage

  • Before the patient is sent home from the hospital, the discharge planner will arrange Medicare home health through a Medicare-certified agency if you are eligible.
  • The patient is sent home – wherever that may be (house, apartment, board and care, memory care, assisted living, etc.).
  • The Medicare-certified home health agency visits the patient’s home within a couple days to conduct an admission visit that will initiate your Medicare coverage.
  • The Medicare home health agency will provide enough visits to educate you on how to improve your condition, to help you reach established rehabilitation goals, or train your caregiver or loved one to help you. The number of visits depends on your diagnosis and needs. For example, someone with a serious wound will have a different visit schedule than someone needing guidance on managing their diabetes.
  • Once the Medicare home health agency has fulfilled its care plan, they will discharge you from their care.

Windward Home Health

After the Medicare home health agency has discharged you from their care, you may continue to need in-home nursing care, whether it’s ongoing or for a limited time. Because Medicare has discharged the patient from its care, further home health services are private pay, meaning the patient pays out of pocket.

Windward Home Health provides care for clients with a range of needs, including adults with developmental disabilities, those who are recovering from an injury or illness, and those who need daily nursing support. The benefits of working with Windward Home Health include continuity of care, reduced hospital and ER visits, and compliance with doctors’ orders and prescriptions.

Windward Home Health bills the patient/client directly and does not accept insurance or Medicare. If you have long-term care insurance, that coverage may provide reimbursement.

Getting started

Getting started with Windward Home Health is as simple as picking up the phone for a complimentary consultation. Reach out to us at 619-450-4300 or email Inquiry@WindwardHomeHealth.com.

During our initial call, we’ll review your needs and preferences. Our RN Case Manager will then conduct an in-home assessment and will create a plan of care based on your physicians’ orders, with your input.