There are different types of nursing homes. When you request nursing care at home, the financial support depends on several factors: liberal nurse or structure, coverage of your mutual insurance or not.
Home Care: What Reimbursement from Social Security?
To find out how Social Security will cover your home care, you need to distinguish between the different types of actions:
- Home care (SAD): this refers to the actions prescribed by prescription, carried out by nurses in the home, such as a blood test, dressings, etc. In this case, social security allows for a reimbursement of up to 60%. It is therefore your mutual insurance company that covers the remaining 40%
- Nursing care in connection with hospitalization at home (HAD): only a medical team responsible for the patient can decide to set up hospitalization at home. This is generally the case in connection with palliative care or to reduce hospitalization time! The cover in HAD corresponds to the cover for hospitalization, i.e. reimbursement of up to 80% or 100% for people with ALD (Long-Term Condition)
- Home nursing care (SSIAD): this system is intended for dependent people over 60 or for younger people with disabilities. This type of home nursing care is fully covered by health insurance
What reimbursement from mutual health insurance for home care?
Your mutual insurance company offers a reimbursement of up to 40% for current home care. However, you should know that nurses working in private practice can set their own rates and thus invoice excess fees. If this is the case, it is imperative that your mutual insurance policy covers this excess rate!
Does your supplementary health insurance not cover the excess fees for home care? In this case, you have the possibility to adjust your contract thanks to an amendment. You can also turn to home nursing structures that charge the rates set by Social Security.
>>I find the mutual insurance adapted to my needs
How do you get a refund for the nursing home?
The reimbursement procedure for nursing homes depends on your situation:
- 100% coverage: In this case, you incur no upfront costs, as the health insurance covers your care in full. People who benefit from 100% social security benefit are people on ALD, pregnant women from the third trimester of pregnancy and people with loss of autonomy or with disabilities.
- Coverage at 60% SS: The health insurance therefore covers 60%, the remaining 40% is your responsibility. If you have mutual insurance, complete it to get a full refund.
Good to know: Regardless of the level of coverage, you must always have a doctor’s prescription marked “Home” in order to be reimbursed. In addition, your mutual care is carried out either through third-party payment (you do not advance the costs), or against presentation of a paid invoice (you must make advances from mutual).
