YOU ASK:

Does health insurance pay for home care after surgery?

WE ANSWER:

Like most benefits, it really depends on the health insurance plan you avail of. And depending on the plan you get, the level of coverage for after-surgery care will also vary.

However, for surgery-related benefits, home care may not be on the top of the list of benefits being provided. What standard health insurance policies pay for usually extend up to your stay in the hospital. After that, you may very well say that you are on your own when it comes to expenses related to your recovering after surgery.

But it doesn't hurt to check if your health insurance plan does cover home care. If you already have an existing plan, take a look at the booklet of benefits and exclusions that the insurance company provides.

Home care may include these services:

  • Physical or occupational therapy
  • Nursing services
  • Certified nursing aid or personal care provider services
  • Speech therapy
  • Companion
  • A professional who can provide overnight or 24-hour care

You can look into possible sources of coverage for home care.

  • Private health insurance. Your plan may provide a certain level (although limited) for in-home care after your surgery.
  • Medicare. This will be covered only for services that are deemed medically necessary by a doctor. The coverage is also limited to so many days (usually six weeks). The homecare being referred here is only for skilled homecare and will not pay for companions, unskilled care or 24-hour care.
  • Medicaid. This can pay for Home and Community Based providers (i.e. companions and unskilled care). Medicaid usually pays for services such as homemaking and personal care assistance. This may also include a caregiver who is a member of the family.
  • Long Term care insurance. You can consider getting this policy since this will cover home care assistance. You should check, though, to see exactly under what conditions this coverage will pay for home care.
  • VA insurance. Veterans Administration can also provide for homecare - you should inquire from the local VA representative if you can avail of this.
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