Types of Insurance Plans

There are several types of insurance plans, and most insurance companies offer plan levels. These plans have different types of coverage. Understanding the differences between the plans is essential in the coordination of care and reimbursement. These differences can include prior authorizations, billing codes, and time file limits.

Insurance plans that include home health coverage include the following: 

• Preferred provider organizations (PPO) 

Consumer selects a primary care physician from a list of preferred or network providers 

- Plan may have copay, deductible, and/or coinsurance 

- Referrals require prior approval from the primary physician

• Point of service (POS) 

- Consumer selects a primary care physician 

- Plan may have copay, deductible, and/or coinsurance 

- Consumer is able to refer themselves to another physician

• Health maintenance organizations (HMO) 

- Consumer selects a primary care physician from a list of preferred or network providers

- Most plans have copays; some may have an additional deductible 

- Referrals require prior approval from the primary care physician

Medicaid home health billing basic

Medicaid
Medicaid is a joint Federal and state program that helps pay medical costs if you have limited income and resources and meet other requirements. Some people qualify for both Medicare and Medicaid (these people are called “dual eligibles”).
If you have Medicare and full Medicaid coverage, most of your health care costs are covered.
Medicaid programs vary by state. They may also be called by different names, like “Medical Assistance” or “Medi-Cal.”
People with Medicaid may get coverage for services that Medicare doesn’t fully cover, such as nursing home and home health care.

Each state has different Medicaid income and resource limits and other eligibility requirements.

In some states, you may need to apply for Medicare to be eligible for Medicaid.
Call your State Medical Assistance (Medicaid) office for more information and to see if you qualify. Call 1-800-MEDICARE, and say “Medicaid” to get the telephone number for your State Medical Assistance (Medicaid) office. You can also visit www.medicare.gov.