Many seniors prefer getting support and assistance from the comfort of home, whether it’s skilled nursing care, physical therapy, or help with everyday tasks. In many situations, receiving in-home care is less expensive and more convenient than going to a facility. Fortunately, Medicare can help pay for certain services at home. While essential medical services are often covered by Medicare, many nonmedical services aren’t. It’s important to understand exactly what’s included in your loved one’s Medicare plan, which unique in-home services they need, and whether your loved one meet key eligibility requirements.
Our free tool provides options, advice, and next steps based on your unique situation.
Medicare does pay for home health care and covers many of the services formerly only available at a hospital or skilled nursing facility.[01]
The coverage is provided under Medicare Part A (hospital insurance) and Part B (medical insurance).[02] Additionally, Medicare Part D can help pay for prescription drugs a senior may need. Home health care services must be provided by a Medicare-certified home health agency, not a family member.
Our free tool provides options, advice, and next steps based on your unique situation.
Not everyone with Medicare is eligible for home health care. To qualify, beneficiaries must meet the following eligibility requirements:
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Medicare covers home health care services that are considered both reasonable and necessary for the treatment of an illness or injury. Medicare benefits for home health care coverage include the following:
Medicare beneficiaries pay nothing for covered home health care services, though the deductible for Part B does apply.
Here’s a closer look at how these Medicare benefits can help someone receiving home health care:
Medicare has limitations regarding how long it will cover home health care. Medicare will only pay for home health care if a senior requires skilled nursing for under eight hours a day, fewer than seven days a week, and no longer than three weeks.
The coverage may be extended longer than three weeks if a doctor can foresee when the senior’s need for skilled nursing will end. If they need full-time skilled nursing for an extended period, then Medicare won’t pay for home health care after a certain point.
Medicare won’t pay for home health care for people with Alzheimer’s disease and other types of dementia unless they’re homebound and a doctor orders covered services. However, they may be able to use social security benefits to pay for in-home care. In addition, any services must be related to other health conditions, such as rehabilitation after surgery, instead of simply care needed as a result of dementia.
However, Medicare will pay for other services often needed by people with dementia, including home safety evaluations, cognitive assessments, care planning, hospital stays, and prescriptions if they have Part D coverage.[03]
Read more: Does Medicare Cover Dementia Care? A Detailed Look
Medicare won’t pay for home care if nonmedical assistance is the only type of service that a senior needs.
Understand that home health care and home care are not the same. While home health care provides medical services intended to help someone recover from an injury or illness, home care offers ongoing nonmedical assistance to people who can no longer live independently. For example, home care services might include housekeeping, transportation, meal preparation, and personal care (e.g., bathing, using the bathroom, and grooming).
However, Medicare home care benefits may cover personal care that’s provided in conjunction with eligible home health services, such as transitional home care services.
Read more: Ways to Pay for Home Care for Seniors
Some in-home care services are not included in Medicare plans. However, home health care agencies are required to provide an Advance Beneficiary Notice of Non-coverage (ABN) before providing services or supplies that Medicare likely won’t cover.
Common reasons that a home health agency might provide a senior with an ABN include the following:
The directions for getting an official decision should be included in the ABN, and seniors have a right to appeal if Medicare won’t pay.
If a family member needs help finding home care, A Place for Mom’s Senior Living Advisors will go over options in your loved one’s area that best fit their needs. Additionally, a Senior Living Advisor can provide information about other senior living options such as independent living, assisted living, and memory care — all at no cost to seniors and their families.
To find home health care, seniors and their families can talk to a doctor or hospital discharge planner, visit the Medicare.gov website to compare options, or contact their local Area Agency on Aging.
Centers for Medicare and Medicaid Services. (2020, September). Medicare and home health care. Medicare.gov.
Centers for Medicare and Medicaid Services. (2022, September). Medicare and you. Medicare.gov.
Centers for Medicare and Medicaid Services. (2017, August). Medicare and Medicaid benefit for people with dementia. CMS.gov.
The information contained on this page is for informational purposes only and is not intended to constitute medical, legal or financial advice or create a professional relationship between A Place for Mom and the reader. Always seek the advice of your health care provider, attorney or financial advisor with respect to any particular matter, and do not act or refrain from acting on the basis of anything you have read on this site. Links to third-party websites are only for the convenience of the reader; A Place for Mom does not endorse the contents of the third-party sites.
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