LAPRA Skilled Care Copays

Overview

Skilled care under LAPRA includes home health nursing, physical therapy, occupational therapy, speech therapy, and medically necessary skilled services ordered by a physician. Copays differ depending on whether the retiree is enrolled in Anthem PPO, Anthem HMO, or Kaiser HMO. Skilled care is covered only when medically necessary and provided by a licensed clinician through a contracted home health agency.

Copay Comparison Table

Plan	Home Health Skilled Nursing	Physical / Occupational / Speech Therapy	Skilled Care Notes
Anthem PPO	Typically 10% to 20% coinsurance after deductible	10% to 20% coinsurance after deductible	Coverage requires a physician order and a contracted home health agency. PPO members may use out-of-network providers but pay higher coinsurance. Skilled care is covered; custodial care is excluded.
Anthem HMO	$0 copay	$10 to $20 copay per visit	HMO members must use in-network providers and obtain authorization. Skilled home health is generally covered at no cost. Therapy visits have small fixed copays.
Kaiser HMO	$0 copay	$10 to $20 copay per visit	Kaiser provides home health through its own contracted agencies. Skilled nursing is fully covered. Therapy visits have small fixed copays. Custodial care is excluded.

Interpretation

Anthem PPO exposes retirees to coinsurance for skilled care, meaning costs vary with the intensity of services. Anthem HMO and Kaiser HMO provide more predictable costs, with skilled nursing covered at no charge and therapy visits requiring modest copays. None of the LAPRA plans cover custodial home care, even if the caregiver is licensed.

Conclusion

LAPRA covers skilled care when medically necessary, but the cost structure differs significantly between PPO and HMO plans. PPO members pay coinsurance, while HMO members generally pay little or nothing for skilled nursing and modest copays for therapy. Custodial care remains excluded across all plans.