Paying for home health care in Illinois is less complicated than most families fear — but only when you understand which benefit applies to which situation. This guide breaks down every realistic option for paying for skilled home care in Illinois, what each one covers, and what each one doesn't.
What "home health care" actually means
Before you can match coverage to care, you need to know what you're buying. The term "home care" gets used for three very different things:
- Home Health Care — Short-term, doctor-ordered, medically necessary skilled care delivered in your home. Includes nursing, physical therapy, occupational therapy, speech therapy, medical social work, and home health aides. This is what Medicare and most insurance covers.
- Home Care (non-medical) — Companion care, help with bathing, light housekeeping, meal prep. Typically private pay or covered by long-term care insurance, not standard Medicare.
- Hospice Care — End-of-life comfort care, covered by Medicare's separate Hospice Benefit.
Optimum Healthcare Services provides Home Health Care under the first definition. Everything below applies to that category.
Medicare home health coverage
If your loved one has Original Medicare (Part A and Part B) and meets a few criteria, Medicare pays 100% of approved home health visits — no copay, no deductible, no maximum visit cap.
The four Medicare home health rules:
- A doctor must certify medical necessity and sign an order.
- The patient must be "homebound" (leaving the home requires considerable effort).
- Care must be intermittent or part-time, not 24/7.
- The agency must be Medicare-certified (Optimum is).
Common services covered: skilled nursing, physical therapy, occupational therapy, speech-language pathology, medical social services, home health aide care (when receiving skilled care), and necessary medical supplies.
Illinois Medicaid (HFS) home health
Illinois Medicaid — administered by HFS (Healthcare and Family Services) and through managed care organizations like Meridian, Molina, CountyCare, and Aetna Better Health — covers home health care for eligible adults and children.
Coverage closely mirrors Medicare for adults but is generally more flexible for children and patients with complex disabilities. Optimum is contracted with all major Illinois Medicaid MCOs.
If you have dual eligibility (Medicare + Medicaid), Medicare pays first and Medicaid covers what Medicare doesn't — including, often, longer aide hours.
Medicare Advantage and private insurance
Medicare Advantage plans (Aetna, Humana, BCBSIL, UnitedHealthcare, Cigna, etc.) must cover at least what Original Medicare covers — but most also offer enhanced home health benefits, including more aide hours, in-home meals after discharge, and chronic care management.
Commercial insurance through an employer typically covers home health under medical (not LTC) benefits, with copays or coinsurance similar to specialist visits. Always verify before care starts.
Optimum is contracted with 13 major Illinois insurance plans and verifies coverage in under 24 hours.
Long-term care insurance
If your loved one purchased long-term care insurance years ago — dust off the policy. These often pay a daily benefit ($150–$300/day) for home care, including non-medical companion care that Medicare won't cover. Activation typically requires inability to perform 2+ activities of daily living (ADLs) like bathing or dressing.
Out-of-pocket costs
If insurance doesn't apply, average Illinois rates for private-pay home care:
- Home health aide: $30–$38/hour
- Skilled nurse visit: $150–$250/visit
- Physical therapy visit: $130–$200/visit
Many families combine partial insurance coverage with limited private pay to extend care hours.
VA benefits
Veterans enrolled in VA healthcare may qualify for Home-Based Primary Care, Aid & Attendance benefits, or Veteran-Directed Care — all of which can fund home health services. Optimum coordinates with VA case managers across Illinois.
How to verify your coverage
Don't guess. Most Illinois families overestimate what they'll pay and underestimate what's covered. Optimum offers a free, no-commitment coverage check in 24 hours: call (773) 878-8738 or submit your insurance card on optimumhhs.com.