Does Medicare Cover In-Home Care? Requirements & FAQs

Does Medicare Cover In-Home Care? Key Takeaways

• Medicare covers skilled in-home care, like nursing, therapy, or medical social services, if it’s medically necessary and provided by a Medicare-approved agency
• Custodial care is not covered by Medicare unless it’s part of a doctor-approved medical care plan
• To qualify for insurance costs, your loved one must be homebound, need part-time skilled care, and be under a qualified provider’s supervision

A health emergency, like a fall or heart attack, might lead to a short hospital stay, but recovery often continues at home.

If you need support after discharge, Medicare can cover certain home health care services.

In fact, many older adults rely on this kind of support. About 3.7% of traditional Medicare and 2.7% of Medicare Advantage beneficiaries recently received home health care, according to the Research Institute for Home Care.

In this guide, we will:

• Clarify what types of in-home care Medicare does and doesn’t cover
• Explain Medicare Parts A, B, and D
• Highlight how Always Best Care supports families through personalized care plans, Medicare guidance, and coordinated in-home services

Does Medicare Cover In-Home Care?

Yes, Medicare does cover certain skilled home health services, like nursing or physical therapy, if your elderly loved one is considered homebound and the care is medically necessary.

Understanding the Parts of Medicare

Before you choose coverage, it helps to understand how the different parts of Medicare work.

1. Part A: Hospital Insurance

Part A helps cover the cost of hospital stays, care in a skilled nursing facility, hospice care, and some home health services.

Most people don’t pay a premium for Part A if they’ve worked and paid Medicare taxes.

2. Part B: Medical Insurance

Part B helps with routine medical care, including:

• Home health care
• Doctor visits and outpatient services
• Preventive care like screenings, vaccines, and annual wellness visits
• Medical equipment such as walkers, hospital beds, and wheelchairs

3. Part D: Prescription Drug Coverage

Part D helps pay for prescription medications, including many commonly recommended vaccines, such as:

• Pneumococcal vaccine
• RSV vaccine
• Flu vaccine
• Polio vaccine
• Shingles vaccine

You can add drug coverage to Original Medicare through a standalone plan or choose a Medicare Advantage plan that includes it. These plans are offered by private insurers that follow Medicare rules.

4. Medigap: Supplemental Insurance

Medigap is optional coverage sold by private insurers to help with out-of-pocket costs not fully covered by Original Medicare, like copayments, coinsurance, and deductibles.

Plans are standardized by letter (think Plan G and Plan N), and the benefits are the same regardless of the provider offering the plan.

Care Services Covered by Medicare

If your loved one is eligible, Medicare will cover a wide range of in-home services, including:

• Skilled nursing care
• Medical social services
• Certain medical supplies
• Physical, occupational, and speech therapy
• Telehealth services, like virtual check-ins or therapy appointments, depending on current Medicare guidelines

Medicare B also typically covers 80% of the approved cost for medically necessary equipment, such as walkers or wheelchairs.

If a service or item isn’t covered, the agency must give you a written notice in advance, called an Advance Beneficiary Notice of Noncoverage (ABN).

If you disagree with the decision, you have the right to file an appeal.

Does Medicare Cover Home Health Care for Dementia?

If you’re caring for someone with dementia, knowing what Medicare actually covers can take a lot of weight off your shoulders.

While Medicare doesn’t specifically offer dementia-focused home care, it can cover certain in-home health services if specific medical requirements are met.

Here’s a closer look at what’s covered:

• Skilled nursing care: If a healthcare provider determines that skilled care is medically necessary, such as wound care, injections, or monitoring of a chronic condition, Medicare Part A might provide coverage. Keep in mind; this is typically short-term and not intended for ongoing daily care.
• Therapy services: Medicare Part B might help cover physical, occupational, or speech therapy if your doctor recommends it, and the care is provided by a certified home health agency.
• Medical social services: These services can include emotional support, counseling, or help connecting with community resources for dementia-related care.
• Part-time home health aide support: If your loved one qualifies for skilled home health care, Medicare can also cover a home health aide to help with personal care tasks like bathing or dressing. However, this support must be tied to a medical need, and it won’t be covered for custodial or long-term care alone.

Medicare Eligibility Requirements for In-Home Nursing Care

If you’re helping a loved one recover at home, understanding Medicare’s requirements for home health care can make a big difference in planning support.

Let’s break it down:

• They need to be considered homebound, meaning it’s extremely difficult to leave the house without help, either from another person or a device like a walker or wheelchair.
• They need part-time or intermittent skilled care, such as nursing or therapy, to improve or manage a medical condition.
• They must be under the care of a qualified provider, like a doctor, nurse practitioner, or physician assistant, who has seen them in person either within 90 days before care starts or within 30 days after it begins.
• The care must be provided by a Medicare-approved home health agency.

Does Medicare Cover Personal or Custodial Care?

In most cases, Medicare does not cover long-term, non-medical care, such as help with bathing, dressing, or meal prep, unless it’s tied to a covered home health service.

That said, home health aide services might be covered on a part-time basis if your loved one is already receiving skilled nursing or therapy at home.

These aides can assist with basic personal needs, but only when their care is part of a broader medical plan.

Does Medicare Cover Nursing Home Care Costs?

Medicare generally doesn’t cover nursing home stays or full-time custodial care, which includes non-medical help with everyday tasks like bathing, dressing, or eating.

It also won’t pay for:

• 24/7 home care
• Delivered meals
• Personal care services unrelated to a medical plan
• Homemaker services, such as light housekeeping, laundry, meal preparation, and grocery shopping

However, Medicaid might offer support for long-term care needs, depending on your state and your loved one’s income and health status.

Quality Senior Care Starts With Always Best Care

At Always Best Care, we know that navigating the cost of long-term care can feel overwhelming, especially when you want the best for your loved one without overextending your budget.

That’s why we don’t believe in one-size-fits-all care. Instead, we work with you to build a plan that fits your loved one’s routine and your peace of mind.

Whether you’re looking for occasional support or more consistent, long-term help, you’ll only pay for the level of care that truly makes a difference.

Our experienced and compassionate caregivers provide dependable in-home support.

Fun fact: We’re also here to help you explore whether those services might be reimbursed through your long-term care policy.

Does Medicare Cover In-Home Care? FAQs

Does Medicare pay for in-home care?

For most people on Original Medicare or Medicare Advantage, home health care services are covered at no cost.

The only out-of-pocket expense might be:

• 20% of the cost of durable medical equipment, like a cane or hospital bed
• The Part B deductible, if it hasn’t been met yet

Make sure to ask the home health agency to explain which services are covered and what might come at a cost.

How many hours of home health care does Medicare cover?

Medicare typically covers:

• Less than eight hours of care per day
• Up to 28 hours per week

In some special cases, coverage might increase to up to 35 hours per week, but this is limited and must meet specific criteria.

Medicare and Medicaid: what is the difference?

Medicare is a federal health insurance program for people 65 and older, as well as younger individuals with certain disabilities.

Medicaid is a joint federal and state program that provides health coverage for low-income individuals, including:

• Seniors
• Children
• Pregnant women
• People with disabilities

In states that have expanded Medicaid under the Affordable Care Act, coverage also includes low-income adults without children or disabilities.

Medicaid can help pay for home health care, nursing facility services, and even Medicare premiums and related costs.

What’s the difference between Medicare Part A and Part B?

Think of Part A as hospital coverage; it helps pay for things like inpatient stays, skilled nursing facilities, hospice care, and some home health services.

Part B covers everyday medical needs, such as doctor visits, outpatient care, preventive screenings, and equipment like walkers or wheelchairs.

Can I keep my doctor with Medicare?

Yes, you can; just make sure your doctor accepts Medicare. It’s also a good idea to confirm that they participate in Medicare assignment, which can help reduce your out-of-pocket costs.