Login
Home Health Care at Home | HomeHealth - ChristianaCare
Understanding Payment and Insurance for HomeHealth
Understand how home health is covered – before you start.
Most patients use Medicare for short-term, doctor-ordered skilled home health, such as nursing or physical therapy (PT), occupational therapy (OT) and speech therapy (ST). Others use Medicaid, private insurance or private pay. Call 888-862-0001 and a qualified billing specialist will help you understand our services, check your eligibility and explain any out-of-pocket costs.
Paying for Care
We know one of the first questions is how home health is paid for. ChristianaCare HomeHealth is a Medicare-certified agency and accepts a range of insurance plans from Medicare, Medicaid, and commercial plans. Insurance coverage for home health care depends on your eligibility, your doctor's orders, and the services you need. You can explore the types of care we provide and how they may be covered by visiting our home health services page.
Insurance Plans
Medicare
A federal health insurance program (primarily for adults 65+) that pays for short-term, medically necessary home health services when specific clinical criteria are met and care is ordered by your provider and requires skilled nursing or therapy services. Learn more about how home health is covered with Medicare.
Medicare patients receiving home health care must be considered “homebound” for Medicare to cover services, which means a patient requires help to leave their home or the provider orders the patient to stay home.
Medicare requires patients to have a face-to-face visit with a provider either before (within 90 days) or shortly after (within 30 days) the start of home health care services.
Medicaid
A joint federal-state program for individuals with limited income that may cover home health and longer-term in-home support, with eligibility, services covered and access varying by state and program. Learn more about how home health is covered with Medicaid.
Private Health Insurance
Employer-sponsored or individual plans, including coverage offered through private insurance companies, typically cover short-term home health services based on medical necessity, plan benefits and network requirements, often following an illness, injury or hospital stay.
Private insurance generally follows Medicare guidelines for homebound status. Most insurers must pre-approve services and coverage can vary for each member.
Payer | Who Qualifies | What's Typically Covered | Examples | Limits & Out-of-Pocket |
Medicare | Adults 65+ (or under 65 with qualifying conditions) who meet homebound and intermittent skilled need criteria with a physician care plan | Skilled nursing, PT/OT/ST, medical social services, limited home health aide (with skilled care) and some medical supplies | Post-surgery recovery at home with nursing visits, stroke rehab with PT/OT and medication management after hospitalization | Must meet strict eligibility criteria and be considered “homebound,” no 24/7 care, no custodial care alone and services are intermittent (most services are fully covered if criteria met) |
Medicaid | Individuals with limited income/resources who meet state-specific medical eligibility | Skilled care and broader personal care and home aide services in many programs | Ongoing personal care support at home, assistance with bathing or dressing and chronic condition management | Varies by state and |
Private Insurance | Depends on the plan (employer-sponsored individual plans may be eligible) | Short-term skilled home health (nursing and therapy), sometimes includes limited aide services | Rehab after injury with authorized therapy visits and nursing follow-ups after discharge | Often requires prior |
What to Expect for Payment and Insurance
- Referral & eligibility check: Our Intake specialist will verify your home health benefit and confirm you meet home health criteria, including homebound status and a need for intermittent skilled nursing care. Your physician provides an order and establishes a personalized care plan.
- Coverage verification: Our team will work with you and your insurance provider to verify benefits and when required obtain authorization for home health services. Coverage varies by insurance plan and individual circumstances. Your financial responsibility depends on your insurance coverage and the services you receive. Depending on your plan, you may have:
- no out-of-pocket cost for covered services
- copayment or coinsurance
- deductible
- Care plan & start of care: A clinician will conduct an in-home assessment and develop a personalized care plan, including your visit schedule and the service and support you’ll receive.
We will make reasonable efforts to explain your expected financial responsibility before services are provided. Insurance benefit verification is not a guarantee of payment or coverage. Your insurance plan determines the final amount covered and your responsibility.
Review ChristianaCare HomeHealth’s Financial Assistance Policy.
Frequently Asked Questions
To qualify for Medicare-covered home health services, you must:
- Be homebound (leaving home requires considerable effort)
- Need intermittent skilled care, such as nursing or therapy (not full-time care)
- Have a doctor's order and a regularly reviewed care plan
- Receive care from a Medicare-certified home health agency
Typically covered:
- Skilled nursing care (part-time or intermittent)
- Physical, occupational and speech therapy
- Medical social services
- Home health aide (limited) when skilled care is also provided
- Certain medical supplies related to your care
Not covered:
- 24/7 care at home
- Meals delivered to your home
- Homemaker services only, such as cleaning or laundry
- Custodial or personal care only (if no skilled need exists)
Yes, Medicaid may cover home health services, but benefits vary by state. Coverage depends on:
- Financial eligibility (income and assets)
- Medical necessity and the level of care needed
- Whether services are delivered through fee-for-service or managed care plans
If you're unsure what you qualify for, review our HomeHealth Financial Assistance policy.
Private insurance plans vary widely, but most require:
- A determination of medical necessity
- Homebound status
- Prior authorization before services begin
- Use of in-network providers
Coverage may include short-term skilled care after illness, injury or surgery, but often has:
- Visit limits or duration caps
- Copays, coinsurance or deductibles
- Differences in whether home health aides or additional services are included
Custodial care, or help with daily activities like bathing, dressing or meal prep, is not typically covered by Medicare unless it's paired with skilled care.
Other options include:
- Medicaid programs or waivers (if eligible)
- Long-term care insurance (if you have a policy)
- Private pay services for flexible, ongoing support
- Community resources, such as local aging services or nonprofit programs
If you need help exploring these options, our team can guide you to appropriate resources and support services in your community, including information on hospice care when it may be the right fit.
Contact Us to Get Started
Our experienced team is here to help you understand your HomeHealth options, verify coverage and connect with your doctor to determine eligibility.
For questions about insurance, coverage, or payment, please contact our Referral Intake team, who can coordinate with a billing specialist as needed. Contact us at 1-888-862-0001.
Useful Links
Financial Assistance Policy: Financial Assistance Policy CCHH (PDF)
Choosing Wisely: Colds, flu, and other respiratory illnesses in adults (PDF)
Choosing Wisely: Antibiotics for a sore throat, cough, or runny nose (PDF)
Related Content
