Home or Nursing Home Care
Health plans offer limited coverage for home care and nursing home care.
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How to get the care
- You need a referral from your doctor and pre-approval from your plan.
- Usually this care must follow a hospital stay.
- The number of days you can get care is limited.
- You may pay a large co-pay or co-insurance.
- The nursing home or home health care provider must be in your health plan’s network.
Home health care
- This includes physical, occupational, and speech therapy. It also includes medication management, nutrition services, wound care, dialysis care, and ostomy care.
- You must be unable to leave your home and your plan must agree that your home is the best place for you to receive care.
- If you have a low income, In-Home Support Services (IHSS) may pay for a home care worker or family member to care for you at home. Call your county Social Services office.
Nursing home care
- This is care in a skilled nursing facility (SNF) under the direction of a doctor and registered nurses.
- You must need skilled nursing care, not just help with daily activities like dressing and eating.
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To choose a nursing home, visit several nursing homes in your plan’s network. Compare the location, cleanliness, noise level, food, and safety of each place. The California Registry helps people find a nursing home.
Medicare
- Medicare plans have special rules.
- If you have Medicare and feel that your nursing
home is sending you home too soon, or your home health care is ending too soon, call Lumetra at 1-800-841-1602.
Long-term care
Most health plans do not cover long-term care. This is care people need because they can no longer feed themselves, bathe, or care for their other daily needs.
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