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Health insurance for home care

Home care services aren't covered by Medicare, but there are some other government schemes. Private health insurance can cover some other costs with both extras and hospital cover.

What you need to know

  • Home care can be an amazing way to get health care in a more comfortable environment.
  • While Medicare does not cover home care, there are a few government schemes that can help with the cost.
  • Private health insurance offers some extras options for home care, in some situations.

What is home care?

Simply, home care is medical care at home, rather than in a hospital of doctor's office. Home care offers older Australians an alternative to residential aged care, but it also lets people recover from hospital treatments in their own home.

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

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

Does Medicare cover home care services?

Medicare doesn't directly cover home care, but the Australian government funds it through two programs, the Commonwealth Home Support Programme and the Home Care Packages Program. There's also the NDIS, if you qualify.

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

NDIS home care support

The National Disability Insurance Scheme, or NDIS, is made to support people aged 7 and up with a disability. There are a lot of support options available if you're eligible for the NDIS, including home care when it's required. Note that if you're over 65 years old, you'll need to have been on the NDIS before you turned 65 to be eligible.

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. What's available differs based on

Home care on private hospital cover

  • 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.
  • Telehealth. Several health funds offer free telehealth services with their hospital cover. For example, Medibank has a 24/7 nurse hotline and mental health support phone number you can call. This isn't really provided under hospital insurance though, it's more like a perk based on your fund.

Home care on extras cover

Some insurance funds offer extras benefits that can be taken at home. This can vary wildly, as it's not typically covered under the core list of extras treatments that the government publishes data on each month. Your best bet for finding out more is to speak to your current extras fund, or to compare new funds online.

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