Frequently Asked Questions
When does Medicare pay for home health services?
Medicare covers home healthcare for homebound individuals when there is a medical necessity. This may include nursing; physical, occupational or speech therapies; and non-medical personal care. This care is paid through the open/traditional Medicare plan or Medicare HMO’s. You may contact us for any Medicare related services that you may need.
Are home health services covered for individuals without Medicare?
Home healthcare services that are medical in nature, such as services needed after a surgery or hospital stay, may be covered by private, commercial, and employer-sponsored insurance plans. Plans vary widely in their coverage options for home health care. Most plans typically offer some sort of home health coverage when the services needed are medically necessary. It is important to check if a home health agency is “in network” with your insurance plan. Providence Healthcare Services is in network with a large number of health insurance plans and we can help you with your coverage and eligibility questions.
Medicaid recipients may also receive home health services if they are under the care of an attending physician and the services needed are medically necessary for the treatment of a specific disease or impairment. Providence Healthcare Services is a provider of Medicaid home health services. We can help you determine if you are currently eligible for these services and answer any questions that you may have.
What is the difference between home health services and home care?
Although these two terms may be used interchangeably, it is important to note that they are often differentiated in hospitals and other healthcare settings. Home health services are provided on an intermittent basis to help patients recover after a hospital stay due to illness or surgical procedures. The services are rendered under the care of an attending physician and they are covered by Medicare, Medicaid, or other private and commercial insurance programs.
Home care services are typically non-medical in nature and they offer support and assistance with activities of daily living for the elderly or other individuals with certain illnesses or physical disabilities. Home care services are generally not covered by Medicare and other insurance plans.
The Florida Medicaid program covers both home health care and home care services under certain qualifying criteria or member enrollment in specific programs. For more information on Medicaid services that you may be eligible for, you may visit https://ahca.myflorida.com/Medicaid/ .
What is the difference between Long Term Care and Private Homecare?
Private homecare, sometimes referred to as Private Duty, are private payments for homecare services billed directly to the recipient of the services or to a responsible party.
Some individuals may have private long-term care insurance policies that cover non-medical homecare services such as personal care, companions, homemaking, and respite care. Long term care policies cover assistance that can be from a few hours, up to 24 hours a day. Some Medicaid recipients may also qualify for long-term care coverage.
As opposed to home health services prescribed by physicians and covered by Medicare, Medicaid, or commercial insurance plans, long term care services are typically consumer-driven allowing a greater level of control over the delivery of your care.
What services will I need?
Your doctor will determine which home health services you will need based on your medical condition. Our team of clinicians, in coordination with you doctor or physician group, will develop a plan of care specific to your healthcare needs.
Private and long-term care services are based on individual needs. Medicaid Long Term Care services are determined by the member’s health plan.
What insurances do you accept?
We are Medicare and Medicaid certified. We accept open Medicare and most Medicare Advantage plans (HMOs). We are contracted with health plans enrolled in the Florida Statewide Medicaid Managed Care (SMMC) program. We also work with several large networks and can accept private and commercial insurances and some international health plans. You may view our complete list of health plans or contact us for more information on insurance plans that we accept and to assist you with eligibility questions.
When can I start care?
Medically-necessary services may be initiated after receipt of a physician’s order and/or insurance authorization. Many insurances require prior authorization before services may began. Certain paperwork may also be required by the State to be completed before services may be initiated. Once the required documentation is complete we can commence immediately. Medicare cases are started 24–48 hours after receipt of physician orders. Medicaid services may take longer to be authorized but typically are started within a week of obtaining all the required paperwork from your physician or health plan. Private Homecare may be initiated upon client request.
In the event of a natural disaster or an emergency, is there a plan to provide care?
Yes. We have a comprehensive Emergency Management Plan which is reviewed and approved by the State each year. In addition, we work closely with local authorities to ensure our patients are prepared prior to and well cared for during and after a natural disaster or an emergency.