Financial Information
Public Third-Party Payers
SHIIP (Senior Health Insurance Information Program)
Medicaid Iowa
- Medicare
If you are 65 or older, you may be eligible for the federal Medicare program. Patients who are homebound, under a physician's care and in need of medically necessary skilled nursing or therapy may be eligible for Medicare coverage. A physician must authorize and periodically review the home healthcare plan of the patient. Home healthcare services covered by Medicare must be intermittent or part time and provided by a Medicare-certified home health agency such as Iowa Health Home Care. Hospice care coverage by Medicare requires certification from a physician.
In addition, durable medical equipment is covered under part B. The equipment would include items such as oxygen equipment and supplies, wheelchairs, walkers and hospital beds ordered by doctor for use in the home. Some items must first be rented. Under traditional Medicare, you pay 20 percent of the Medicare approved amount and the part B deductible applies. You must get your covered equipment or supplies form a supplier enrolled in Medicare, which includes Iowa Health Home Care.
- Medicaid
Medicaid, a program for low-income individuals, is funded jointly by the federal and state government. Eligibility varies from state to state. However, all states are mandated to provide home health care coverage to people who:
- Receive federal income payment assistance such as Social Security income or Aid to Family with Dependent Children (AFDC).
- Are deemed "categorically needy" (individuals who are aged, blind, and/or disabled with incomes above the mandatory coverage level but below federal poverty levels).
Medicaid programs also have coverage for medically necessary home healthcare, durable medical equipment and hospice. For more information on what Medicaid will cover, please visit Medicaid Iowa.
- Older Americans Act (OAA)
The Older Americans Act, enacted by Congress in 1965, funds state and local social service programs for frail and disabled older individuals to continue their independence in their communities. Coverage may include home healthcare, personal care, meals and shopping, to name a few. Individuals must be 60 years of age or older.
- Community and Social Service Assistance Programs
There are a variety of assistance programs available to individuals of a certain income and ability level. Please contact our financial assistance counselor at (515) 557-3100 for more information.
Private Third-Party Payers
- Commercial Health Insurance
Most commercial health insurance policies cover some home healthcare services for immediate medical needs. However, coverage for long-term services varies. Sometimes commercial insurance companies will pay for professional home healthcare under a cost-sharing plan.
- TriCare
TriCare is the U.S. Department of Defense (DoD) healthcare entitlement for active duty, Guard and reserve, and retired members of the military and their eligible family members and survivors. TriCare could cover certain home care and hospice services. For more information on TriCare, please visit www.tricare.mil.
- Workers' Compensation
If a patient requires medical home healthcare services due to an injury sustained at work, he/she may be eligible for coverage under a workers' compensation plan.
- Managed Care Organizations
Managed care organizations are group health insurance plans. Coverage may include home health and hospice care services. Managed care plans can limit coverage to health care provided by doctors and hospitals that work for or contract with them, also called "network providers". Often managed care plans will require you to get permission, or a referral, from your family doctor before you get care from a specialist in their network. Some managed care plans will reduce coverage for your care if you go to a non-network provider or if you get specialist care without a referral.
What are Medicare Advantage plans and which plans are available in Iowa?
Medicare Advantage plans are offered by private companies which contract with Medicare to provide Medicare Part A, B and sometimes D (prescription drug) benefits. When you enroll in a Medicare Advantage plan you do not lose Medicare, you just get your benefits in a different way. The plans are available to all Medicare beneficiaries except those with end stage renal disease.
There are six types of Medicare Advantage plans in Iowa: HMO (health maintenance organization), POS (HMO with a Point of Service option), PPO (preferred provider organization), PPFS (private fee-for-service), SNP (special needs plan), MSA (Medical Savings Account). In addition, a special type of health plan called a "cost plan" is offered in a few counties.
Before you enroll in a Medicare Advantage plan it's important to know the following:
- Whether or not all of your providers (physicians, hospitals, etc.) accept the plan.
- You must have both Medicare Parts A and B and live in the service area for the plan.
- You must stay in the plan until the end of the calendar year.
(There are few exceptions.)
- Each year plans can change benefits, premiums, service areas, provider networks (if
applicable), and can terminate their contract with Medicare
For more information on plans available in Iowa, please visit www.shiip.state.ia.us or contact the Senior Health Insurance Information Program (SHIIP) at 1-800-351-4664 or visit Medicare's "Compare Health Plans and Medigap Policies in Your Area" page.
Self-pay
If a patient does not meet the requirements of third-party payers, he/she may have to privately pay for home healthcare services.
Financial Assistance
Iowa Health Home Care has a financial assistance program for medically necessary items and services. The amount of assistance is dependent on the number of people in the household, household income, and net worth. For more information, contact our financial counselor at 515 557 3100 or 1-800-584-6311.