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What Insurance Companies Cover Private Duty Nursing?

With a wide range of options, ranging from insurance companies and government programs to out-of-pocket payments, understanding the ideal option that aligns with your needs requires time and extensive research.

Private insurance remains one of the most viable means for paying for PDN care. It is pertinent to note that a good number of major insurance companies cover private-duty nursing on an ongoing basis or for a stipulated period.

While this will most often vary depending on your insurance company, keep in mind that there might be specific medical criteria you or your loved one will be expected to meet to be eligible. As such, you need to reach out to a representative to find out if you are eligible for coverage.

Howbeit, if you or your loved one needs private duty nursing care and are trying to understand the right company to work with, below are the top insurance companies in the United States that offer coverage for private duty nursing.

Insurance Companies That Cover Private Duty Nursing

  1. Medicare

Medicare is renowned as a federal health insurance program that is majorly tasked with seeing to the affairs of individuals aged 65 and older, coupled with younger people with disabilities.

While Medicare is known to extensively cover skilled nursing facility care, you need to understand that it also covers private duty nursing services although within certain stipulated conditions.

To become eligible, individuals will need to be homebound and possess an utmost need for skilled nursing care on an intermittent basis.

Medicare will take care of these services via Medicare Part A (hospital insurance) as well as Medicare Part B (medical insurance).

  1. Medicaid

Note that Medicaid remains a joint federal and state program that is meant to provide health coverage to low-income individuals and families.

Even though Medicaid is administered by states, it complies with federal guidelines in terms of covered services. A good number of states in the United States tend to offer coverage for private-duty nursing services via their Medicaid programs.

Eligibility criteria vary by state, but individuals with disabilities, chronic illnesses, or medical conditions that require skilled nursing care may qualify for coverage.

  1. UnitedHealthcare

UnitedHealthcare has grown to become one of the biggest health insurance providers in the United States, and they focus on a wide array of health insurance plans for individuals, families, and employers.

Keep in mind that a good number of their plans include coverage for private duty nursing services, even though the exact coverage will vary and most often depend on the plan you choose.

UnitedHealthcare will more or less cover skilled nursing care provided by licensed professionals in the home setting; however, do not forget that it will necessitate pre-authorization as well as medical necessity criteria.

  1. Aetna

A well-known insurance firm and a subsidiary of CVS Health, note that they provide health insurance coverage to millions of Americans all over the nation.

It is important to note that their health insurance plans tend to include coverage for private duty nursing services, especially for persons who need skilled medical care at home owing to sickness, injury, or disability.

Additionally, Aetna’s coverage for private duty nursing will also vary and depend on the plan you choose and might involve some level of pre-authorization for services.

  1. Cigna

This is one of the best options in the United States especially when you take into consideration the fact that they are a global health service company that provides a vast array of health insurance plans, such as coverage for private duty nursing services.

According to reports, their plans might cover skilled nursing care as long as it is being provided in the home setting and aligns with all relevant medical criteria and plan-specific limitations.

Cigna will most definitely mandate pre-authorization for private duty nursing services to guarantee that they conform with all stipulated criteria for coverage.

  1. Humana

When considering the best insurance company that covers private duty nursing, you cannot afford to skip Humana. This company has maintained its position as one of the best healthcare companies that offers a wide array of health insurance plans, such as Medicare Advantage, Medicaid, and commercial health insurance plans.

A good number of their plans encompass coverage for private duty nursing services, especially for individuals with complex medical needs who need skilled nursing care at home.

Aside from that, keep in mind that the coversheet for private duty nursing under Humana’s plans might necessitate pre-authorization and full compliance with certain medical necessity criteria.

  1. Blue Cross Blue Shield

This particular company is made up of a network of independent health insurance companies that work together to make it available to millions of Americans across the country.

A good number of Blue Cross Blue Shield plans include coverage for private duty nursing services, even though coverage specifics might vary based on the state and plan chosen.

BCBS will only cover skilled nursing care as long as it is provided in a home setting, while also conforming to medical necessity criteria as well as plan-specific limitations.

  1. Anthem

Anthem is one of the healthcare companies that makes up the Blue Cross Blue Shield network and offers plans in numerous states.

However, as with other BCBS plans, Anthem tends to provide coverage for private duty nursing services as a vital component of its health insurance plans.

However, note that all the plans offered by Anthem necessitate pre-authorization as well as full compliance with specific medical necessity criteria, just the same as with other insurance providers.

Although numerous benefits come with this sort of nursing care, it is imperative to note that getting a full insight into the financial aspects of this service can be quite daunting, particularly when it comes to understanding how private-duty nursing services are paid for. 

Nevertheless, same as with any insurance plan, you must take your time to carefully review the terms, coverage limitations, as well as eligibility for all the policies to guarantee they align with your exact needs and circumstances.