At-Home Health Services Covered By Insurance

At-Home Health Services Covered By Insurance

There are many reasons why someone may need in-home medical services. During the COVID pandemic, many high-risk individuals received their healthcare through virtual or in-home services to minimize transmission risks. 

Even before the pandemic, there were many patients who required in-home services due to medical conditions that require around-the-clock treatment with dialysis machines or oxygen concentrators.

The convenience of in-home care has also increased its popularity with otherwise healthy individuals who want more flexibility in scheduling health appointments.

While in-home healthcare services are widely available, many people do not realize that many of these expenses are covered by public and/or private insurers. There are limitations and restrictions, but if you are considering any of the following in-home services, contact your insurer and see if you qualify for reimbursements.

Eldercare services

Older people who require assistance with daily activities, but can otherwise live independently can benefit from home care services. In-home elder care includes a range of services, from non-medical tasks, like housekeeping and transportation to wound care or vitals monitoring.

Medicaid, the federal health insurance program for low-income Americans, will cover some in-home care expenses for low-income seniors. The actual services covered will vary by state. Seniors on Medicare, the federal insurance program for Americans over 65, can claim home care services recommended by their doctors.

Most private insurers only cover in-home care costs through long-term insurance policies. These plans usually have a higher premium than regular health insurance, but will cover 80 to 100% of medical and non-medical in-home services. However, for the best return, experts recommend purchasing a long-term care policy between the ages of 60 and 65.

Durable Medical Equipment

According to the Centers for Disease Control and Prevention, more than half of American adults have at least one chronic illness. Many of these conditions require monitoring or ongoing treatment to prevent progression. 

Durable medical equipment allows patients to safely receive treatment at home. This improves health outcomes and patient survival rates. At-home treatment options also reduce costly visits to the emergency room or lengthy hospitalizations.

As in-home devices are more economical than the alternative, many DMEs are covered by Medicaid and Medicare. In addition to the equipment itself, public insurers often cover supplies, such as alcohol swabs, lancets, tubing, and required medication.

Medicare will also cover the cost of in-home training for eligible devices. Private insurers will also cover the majority of DME expenses. However, patients are expected to cover an out-of-pocket copayment. 

Home-based Blood Draws

Many diagnostics tests require blood samples, which must be performed by a trained medical professional. This requirement has caused a gap in health access, as patients often skip or miss doctor’s appointments. Diagnostic delays can lead to disease progression and complications. 

To reduce obstacles to getting laboratory tests, many healthcare systems now partner with private laboratories, such as Quest Diagnostics. For example, patients can schedule a Quest lab appointment at the most convenient location. 

If their schedule conflicts with the laboratory’s hours, or there is no convenient location, some labs will send a phlebotomist to the patient’s home to collect the sample. While patients must pay a small fee for the in-home draw, the patient’s insurance will cover the laboratory results. 

Self-administered at-home blood test kits can also be covered by Medicare, provided that the test is medically necessary. 

Online Therapy

Teletherapy is one of the fastest-growing segments of telehealth. In 2021, nearly a quarter of Americans reported using online counseling services. 

Teletherapy addresses many of the issues with traditional in-person mental health services, which includes a shortage of qualified professionals, long waiting lists, and stigma.

As teletherapy is relatively new, states have only recently included the service as an eligible expense under public insurance programs. However, in 41 states, private insurers can also cover teletherapy services. 

Teletherapy may be provided by a health care system through its online portal, or through an independent company, such as BetterHelp or Talkspace. Patients must contact their insurance provider to verify that the sessions are covered by their policy. 

Medically-necessary Physical Therapy

Physical therapy helps patients recover after surgery or an accident. It can also be a supplemental treatment for conditions that affect mobility, such as Parkinson’s or multiple sclerosis.

Physical therapists can be found in clinics, hospitals, fitness facilities, in-home health settings, and in many other places. It’s a popular career field in part because travel physical therapy jobs allow adventurous medical professionals exactly what they’re looking for.

Most private and public insurers will cover any physical therapy recommended in a patient’s treatment plan. In-home physical therapy is usually approved on a more limited basis. 

For example, under Medicare, in-home physical therapy is only covered if the patient is homebound and therapy sessions are monitored by a doctor. The physical therapy plan must also be time-limited. Medicaid coverage varies by state. Most states that approve in-home physical therapy put a cap on eligible sessions.