Home care is an important part of our country’s health system. The National Center for Health Statistics reports that more than 4.5 million Americans are currently receiving some form of home health care—with many more people likely to require services in the coming years. In fact, AMN Healthcare estimates that the need for home healthcare services could grow by as much as 40 percent over the next decade. 

This raises an important question: How do you qualify for home health care services in Pennsylvania? Are the options available to help individuals and families afford the cost of much needed home health care services? Here, we explain the key things you need to know about qualifying for home health care benefits under federal programs, state programs, and private insurance. 

Your Guide to Qualifying for Home Health Care Services in Pennsylvania

Medicare 

One of the most common questions people have: Does Medicare cover home health care services? The answer is ‘yes’—but only in rather limited circumstances. If you have Medicare, you may be able to receive home health care benefits if a doctor certifies you as needing home care and you are deemed to be “homebound” under the standards set up by the Centers for Medicare & Medicaid (CMS). Additionally, Medicare only offers coverage for specific home care services. You may be eligible to receive skilled nursing care or rehabilitative services, such as physical therapy or occupational therapy. In other words, home health care coverage is available through Medicare, but it is not comprehensive.

Medicaid

Unfortunately, “non-skilled” personal care—such as assistance with day-to-day activities—is not covered by Medicare. The good news is that there are other options available for elderly and vulnerable people who require these critically important home care services. Under Medicaid, home aide services may be covered for people who meet both medical requirements and pass a financial means test. While Medicaid offers home care services that are not available through Medicare, these services are only covered for applicants who meet the program’s asset/income requirements. 

State Programs 

There are state-based programs in place to assist residents of Pennsylvania who need help obtaining home health services. In fact, as of 2020, Pennsylvania has more than one Medicaid-based program in place through which you or your loved one may qualify for home health services. 

Notably, in 2018, our state began phasing in the Pennsylvania Community HealthChoices (CHC) Program. If you or your loved one is in Southeastern Pennsylvania and needs comprehensive home health services, CHC is often the best place to start. CHC offers medical benefits for senior citizens and other people with disabilities. In fact, through the Pennsylvania Community HealthChoices Program, vulnerable individuals may be able to qualify for personal care services, including assistance with both ADLs and IADLs. Among other things, CHC provides services such as grooming, bathing, meal prep, prescription drug management, counseling, respite care, and much more. 

Private Insurance Coverage 

Finally, some people receive home healthcare coverage through a private insurance policy. Typically, but not always, long-term care coverage that provides home health services is obtained through an employer-sponsored insurance plan—meaning these plans are regulated by ERISA. While there are state and federal regulations in place requiring private long term care insurance, policyholders should review the terms of their individual plan to determine eligibility. 

Our Home Health Care Agency Can Offer Guidance on Eligibility

We know that navigating home health care eligibility can be frustrating and confusing—especially at a time when you and your family may be dealing with a lot of stress. Our Phoenixville, PA home health care agency is here to help relieve some of the pressure. Our mission is to provide patients with reliable care—focusing on compassion, respect, safety, and a commitment to helping everyone enjoy the highest possible quality of life. If you have specific questions about your eligibility for coverage under Medicare, Medicaid, Pennsylvania Community HealthChoices (CHC), or any state-based program, we can help get you answers or put you in touch with someone who can help. 

Call Our Pennsylvania Home Health Care Team Today

At Personal Health Care, our home health care professionals work tirelessly to uphold a tradition of personal care, top quality customer service, and a dedication to excellence. If you or someone you are caring for needs home health support, we can help. Call us today for a free in-home health care assessment. Based in Phoenixville, our home health care professionals serve communities throughout Southeastern Pennsylvania, including in King of Prussia, Pottstown, Exton, Coatesville, West Chester, Wayne, and Royersford.