Health insurance for home care

As you get older and move into your senior years, the ability to maintain your independence and continue living in your own home can make a huge difference to your overall wellbeing. Home care services can provide treatment options tailored to your specific needs that help you stay out of hospital or even enjoy a quicker at-home recovery after surgery.

Let’s take a closer look at the home care services available and how they’re covered by Medicare and private health insurance.

What is home care?

Home care is the provision of clinical care, nursing and allied health services, as well as personal assistance, to older Australians to help them stay in their own home. Home care services are designed to offer older Australians an alternative to residential aged care, allowing them to retain their independence for as long as possible.

Home care programs offer a wide range of services and can be tailored to cover individual needs. Some of the services provided include:

• Practical help, such as cleaning the house, cooking and assisting with shopping
• Personal care, for example help with showering and dressing
• Nursing services, such as wound care and managing medication
• Rehabilitation programs to help with recovery following surgery, an illness or injury
• Palliative care

What home care services are covered by Medicare?

The Australian government provides funding for home care services through two programs:

Commonwealth Home Support Programme.

This entry-level home support program is designed to provide assistance with daily tasks to help senior Australians continue living at home. Services provided include:

• Domestic assistance with jobs, such as cleaning and washing
• Personal care, such as help bathing and dressing
• Minor home maintenance duties
• Minor home modifications, such as the installation of handrails
• Nursing care
• Social support
• Transport to appointments

However, if you receive services through the Commonwealth Home Support Programme you will be asked to contribute towards the cost of those services.

Home Care Packages Program.

The Home Care Packages Program is designed to help people with more complex care needs to retain their independence. There are four levels of home care packages available to suit different care needs, and services provided include:

• Personal assistance, including bathing, showering, dressing, toileting and mobility
• Nutrition, hydration and meal preparation
• Continence management
• Mobility and dexterity, for example providing crutches, walking frames, mechanical lifting devices and more
• Nursing, allied health and other clinical services
• Transport and assistance with shopping and attending social activities
• Management of bandages and dressings

Your Home Care Package provider may ask you to pay a basic daily fee of up to 17.5% of the single basic age pension. If your income is over a specified amount ($25,792 for an individual) you may have to contribute an extra income-tested care fee.

Additional services covered by Medicare

Medicare can also provide some cover for palliative care received at home. Home care must be medically recommended and you may still need to contribute to the cost of medical equipment, medications and at-home nursing care. You can find more details in our guide to health insurance and palliative care.

Older Australians and those living with a disability may also be able to access government subsidies to help cover the cost of home modifications. This can include the installation of ramps, handrails, hand-held showers and emergency alarms, as well as other services such as widening doorways and adjusting bench heights.

Changes in home care

The Federal government introduced the Increasing Choice in Home Care (ICHC) reforms on 27 February 2017. These reforms are designed to provide greater control and increased choice to older Australians in regards to the home care services they receive.

The reforms featured a number of key changes for older Australians accessing home care services, including:

• Funding now follows the individual. Home care package funding now follows you, allowing you to choose the home care provider that meets your needs. Previously, funding was allocated to the care providers.
• Home care packages are now portable. If you decided to change home care providers, any unspent funds will follow you to the new provider. Under the old system, unspent funds would have stayed with your previous provider.
• Home care packages are distributed differently. A national system has been introduced to prioritise access to home care services through the My Aged Care online gateway. This is designed to ensure that packages are distributed based on a patient’s needs, not on where they live.
• New home care package levels. If you apply for a home care package, your needs will be assessed and classified at a specific package level: 1, 2, 3 or 4.

Is home care covered by health insurance?

In addition to the government subsidies that help cover the cost of home care services, you may also be able to access cover from your private health fund. Most home care services usually fall under the auspices of hospital cover policies, but you may also be eligible to receive home nursing services as part of your extras cover.

So what can you claim on your health insurance policy?

• Hospital substitute services. Often referred to by names such as hospital at home or hospital in the home, hospital substitute services are included in hospital cover policies from many private health funds. They allow you to access treatment from specialists such as nurses, physiotherapists and occupational therapists so you can reduce the length of a hospital stay. Some patients may also qualify for domestic assistance (such as help cooking and cleaning) that will be covered by their health fund.
• Home nursing. Often included as part of top-level extras cover policies, home nursing services cover things like wound management, catheter care and medication administration after you have been discharged from hospital, or in some cases can be provided instead of being admitted to hospital.
• Home rehabilitation services. From wound management to physiotherapy and other therapies, some hospital cover policies will help cover the cost of home rehabilitation services following surgery, an injury or illness.
• Palliative care at home. Cover for palliative care is a common inclusion in hospital cover health insurance, and in many cases it may be possible to receive the care you need in the comfort of your own home.

Depending on your health fund, you may also be able to access discounts on in-home care services. For example, HCF members can access a 10% discount off More at Home, an in-home community care service provided in metropolitan Sydney.

However, the cover available can vary widely depending on your health fund and the level of cover you select, so contact your fund for details of the covered home care services available to you.

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