Seniors that have paid into long term care insurance policies from carriers like Genworth, AXA, Lincoln National, Mass Mutual and others, can use those policies to pay for their home care services when they have fulfilled the necessary premium requirements and become eligible. The process for starting home care services and knowing what services you qualify for will depend on the specific terms and conditions stated in each policy. Please check your policy and or contact your insurance carrier for specific details about the process and eligibility requirements for starting services.

Unlike Long Term Care insurance and Medicaid, Private Health Insurance and Medicare do NOT pay for long term care services. They may cover short term care services (30 days or less) for accident and injury related follow up recovery and care at home, etc. A doctor’s prescription or recommendation is needed to get approval from Medicare or your private health insurer to start services. It is important to check with your health insurance provider to determine if they provide a benefit for short term care. Some private health insurers and plans do not provide this benefit.

Medicaid covers a majority of non medical Home Health Care services and the majority of that is long term care related. Over the last few years Medicaid has made arrangements to outsource their fee for service (FFS) to several private insurance companies that act as Medicaid Health Maintenance Organizations (HMO’s). Affinity Care of New Jersey bills these HMO’s and they in turn bill Medicaid.

Medicaid does make exceptions for the few patients who do not select or have an HMO. Some other organizations also pay for long term care like the Veterans Administration (VA) and some state and county organizations.

Affinity Care of NJ is an approved Medicaid home care provider and we accept many major forms of Medicaid HMO insurance. We accept payments from the following Medicaid HMO’s:

Aetna, Amerigroup, Horizon, United Health Care and WellCare.

The Medicaid Process Cycle

–  Seniors living below poverty level apply for New Jersey Medicaid insurance.

–  If they meet all state criteria and are found eligible, the state grants them the insurance.

–  Members have a choice of 5 or 6 state appointed HMO’s to select from.

–  Members who cannot live independently and have demonstrated a need for assistance with their daily living needs must have a doctor provide them with a prescription for a home health aide.

–  Affinity Care of NJ gets the prescription and insurance information from Medicaid and the HMO.

–  Affinity Care of NJ applies for Authorization for home health care services to the Medicaid / HMO.

–  Based on medical necessity, Medicaid / HMO approves or rejects the authorization.

–  Approved authorization triggers the coordination on our part to start services.

–  Upon completion of weekly services, Affinity Care of NJ invoices the Medicaid / HMO.

Starting home care services with a new Medicaid client depends on the Medicaid HMO insurance. We need to get authorization from the insurance company before we start providing care. Once we get the authorization we can begin services immediately.

Regardless of your insurance situation, Affinity Care of NJ stands ready to assist you. Please call us with questions about your specific details and needs or for any information you may need from us to process a claim. Call Us Today! (732) 324 1515