Payment, Insurance & Eligibility
Understanding Your Care Options
Who pays for Home Health, Hospice & Home Infusion Therapy Services?
Home Health:
Medicare, Medicaid, or other private insurance plans may cover Home Health services.
Hospice:
Hospice care is typically covered through the Medicare Hospice Benefit and Medicaid Hospice Benefit. The Medicare Hospice Benefit, included under Medicare Part A (hospital insurance), provides beneficiaries with comprehensive non-curative medical and support services to enhance their quality of life. Additionally, many private insurance plans include hospice coverage.
Home Infusion Therapy:
Medicare Part B covers home infusion therapy when administered intravenously or subcutaneously under certain conditions. The pump is covered under the Medicare Part B Durable Medical Equipment benefit. Private insurance may also cover home infusion therapy.
What Insurance & Health Plans Does AAdi Accept?
AAdi accepts the following health plans:
- Medicare
- Medicare Advantage Plans
- Medicaid -Hospice Only
- Tricare
- TriWest
Private Insurance accepted:
- Aetna Choice / Aetna Medicare
- Blue Cross Blue Shield
- Cigna
- Humana PPO
- Paragon
- Sana
- United Healthcare
- Y Medical
*Other private insurance on a case-by-case approval from benefit verifications.
Eligibility Requirements for Home Health, Hospice & Home Infusion Therapy Benefits
Eligibility Requirements by Service
To quality for hospice care, patients must meet the following criteria:
- Diagnosed with a life-limiting condition by their physician or a hospice physician, with a life expectancy of six months or less.
- Opt for comfort care (palliative care) instead of curative treatments.
- Sign a statement choosing hospice care as their primary treatment for their terminal condition.
Typically, a patient qualifies for home health coverage if they meet the following criteria:
- Homebound Status: The patient must be considered homebound, meaning it is difficult to leave home without assistance (e.g., needing a walker, wheelchair, or help from another person) or leaving home is medically inadvisable due to their condition.
- Skilled Care Needs: The patient requires intermittent skilled care from a registered nurse, licensed vocational nurse, or skilled therapist (physical therapy, occupational therapy, or speech-language pathology) under the direction of a physician.
- Physician’s Order: Home health care must be ordered by a physician who certifies the patient’s homebound status and need for skilled care. The physician also reviews the care plan regularly.
- Medicare Coverage Requirements: The home health agency must be Medicare-certified for Medicare patients, and the care provided must be deemed medically necessary and part of a specific treatment plan.
These qualifications apply to most insurance plans and Medicare, the primary payers for home health services.
Patient qualifications for Home Infusion Therapy (HIT) include:
- A physician must prescribe the home infusion therapy, create a treatment plan, and regularly review and adjust the care as needed.
- The therapy must be deemed medically necessary by the prescribing physician.
- Medicare Part B-approved medication administered through IV or SQ for an administration period of 15 minutes or more.
- Pump medications are covered under the Medicare Part B DME benefit.
- See the full list of Medicare-approved Home Infusion Therapy drugs here.
- The medication and/or biologic is administered in a residential setting by a certified home infusion provider who meets the accreditation standards for safe administration and monitoring.
- The patient does NOT have to be homebound to qualify.
Have questions about eligibility, insurance coverage, or how to get started?
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AAdi Home Health & Hospice Provides exceptional patient-centered care delivered with compassion and expertise by a team that truly cares about your health and well-being.
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