Navigating the financial aspects of healthcare can be overwhelming, especially when it comes to understanding how private duty nursing services are paid for. With so many options, ranging from insurance companies and government programs to out-of-pocket payments, figuring out which route best suits your needs can take time and effort. In this blog post, we’ll walk you through several available payment sources so you or your loved ones can get the care they need.
What is private duty nursing?
Private duty nursing, or PDN, is a form of long-term and comprehensive skilled nursing care that takes place in the home. Depending on your region, it may be called continuous skilled nursing. PDN allows medically fragile patients to receive quality care in the comfort and familiarity of home – a setting preferred by most patients and their families. In addition, PDN care is generally less expensive than a facility stay, costing up to half as much as a single hospital day.
At Maxim, we provide private duty nursing care to both adult and pediatric patients with complex medical needs. Our nurses and clinical supervisors work with your doctors and care team to provide the care you need.
PDN care is tailored for the patient but can include:
- Ventilator and tracheostomy care
- G-tube care and management
- TPN infusion
- Diabetes, seizure or oxygen management
- Medication and therapy administration
- And much more
What payment methods can I use?
Now that you know that private duty nursing is an attractive option. You may wonder, “How much does it cost and how can I pay for it?”
Unfortunately, there is no set cost of PDN care. Although PDN is generally cheaper than hospital or nursing home stays – the cost depends on the hourly rate in your state and the type of care that you or your family member needs. PDN costs range from $27 an hour in North Dakota to $18 in Georgia, North Carolina and Tennessee.
At Maxim, we accept several forms of payment for private duty nursing.
Private insurance is one of the most popular ways of paying for PDN care. Many major insurance companies will cover private duty nursing on an ongoing basis or for a set period. Depending on your insurance company, there may be specific medical criteria you or your loved one need to meet to qualify. Please consult your insurance plan documents or speak to a representative to find out if you have coverage.
Some long-term care insurance policies or life insurance policies with long-term care riders cover private duty nursing. It is important to note that not all long-term insurance policies cover this sort of skilled nursing, so it is important to consult with your insurance representative to understand your coverage.
Another popular way to pay for PDN care is through Medicaid, the joint federal and state program that assists lower-income individuals with healthcare. In-home care and skilled nursing are generally covered under Medicaid.
Because each state runs its Medicaid program differently, the criteria and eligibility requirements vary. To apply for Medicaid, contact your local Department of Social Services and show proof of your financial need for assistance.
TRICARE – ECHO Home Health Care
TRICARE is the health care program for uniformed service members, retirees and their families. TRICARE alone doesn’t cover private duty nursing; however, the Extended Care Health Option (ECHO) offers supplemental services to individuals with moderate or severe intellectual disability, severe physical disability, or extraordinary physical or psychological condition. Private duty nursing, part-time skilled nursing, and respite care are covered under ECHO.
Federal workers’ compensation
At Maxim, we provide a variety of services to certain individuals and their beneficiaries through the U.S. Department of Labor’s Office of Workers’ Compensation Programs (OWCP). This includes beneficiaries in the Department of Energy, Department of Federal Employees, Department of Longshore and Harbor Workers and the Division of Coal Mine Workers Compensation programs.
Qualified beneficiaries will receive a medical benefits card that entitles them to certain care services at no cost. Speak to your local Maxim office to find out more.
Private pay refers to when patients and families pay for care out-of-pocket. This option is commonly used when families need more care than their insurance will cover or if they don’t have an insurance policy with a home health benefit. Often, families use funds from various sources, including annuities, investments, or savings. Although some families borrow against their homes to pay for care, the experts at AARP caution against it. “Keep in mind that using your house to provide care for long-term care is risky. You could run out of equity in your home while you still need the care, and reverse mortgages, complex financial tools available only to people age 62 and up, are a common subject of scams targeting older homeowners.”
At Maxim, we are dedicated to providing quality care and excellent customer service. With over 150 office locations nationwide, our priority is ensuring our patients and families can access on-call support any time they need it – 24 hours a day, seven days a week, including weekends and holidays. Our nurses are thoroughly screened and credentialed with experience providing care for patients with various conditions. Contact your local Maxim office to get started with private duty nursing!