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Does Medicare Cover Home Health Care

Medicare coverage for in-home health care is available in few situations; also, the level of benefits depends on needs. Meaning, qualifying beneficiaries may get coverage for care at home — however, the extent of care comes with restrictions. There are some instances in which Medicare does cover in-home caregivers; we’ll discuss these situations below.

Does Medicare Pay for In-Home Caregivers?

Medicare may cover medically necessary at-home care on a short-term basis. Your doctor must prescribe at-home therapy before Medicare applies. Medicare doesn’t cover in-home care when it involves personal services, and that’s the only care you need.

Under strict guidelines, coverage for in-home caregivers is available. When your parent begins to age, they may become homebound certified by their doctor. In this case, reimbursement for medical in-home services may be available.

The doctor must order rehab therapy visits or intermittent skilled nursing services to treat your condition. Although Medicare only pays for therapy short-term.

Skilled care must be from a certified Home Health Agency through Medicare. However, if you have long-term care coverage, you don’t need to worry about Medicare approval.

Does Medicare Pay for Non-Medical In-Home Care?

Many seniors need help with daily activities like dressing, bathing, doing the laundry or house chores, and other daily activities. In-home care for non-medical reasons doesn’t have coverage. Families often struggle when trying to take care of their loved ones without the support of Medicare.

Caregivers may provide baths on a short-term basis; a healthcare professional must provide these services, and a person’s health status must require home health care.

Medicare Approved Home Health Agencies

In-home services must come through a Medicare-approved Home Health Agency. Medicare covers in-home care for seniors with personal, hands-on care for an intermittent time. Beneficiaries must meet health requirements.

Home health agency services in Florida, Illinois, Michigan, Texas, and Massachusetts may offer a Medicare demonstration program. This program gives you and your home health agency an earlier idea of coverage.

Medicare reviews your situation and pays the allowable expenses if the services are medically necessary, and you meet conditions.

Does Medicare Cover Home Instead?

Home instead is a private company that provides senior care services to help with a variety of issues. The costs for Home Instead care vary; some insurance covers home care, Medicare doesn’t.

However, if there is a medical need for care, Medicare will pay for services at home. Medicare won’t cover things like live-in caregivers, visiting angels, or other custodial services.

Will Medicare Pay for 24 Hour Home Care?

No, Medicare will not pay for 24-hour home health care. A home health care agency typically is the coordinator for any services your doctor orders.

Medicare doesn’t cover around the clock care at home or other home-maker services. Any meal deliveries to your home are not typically available.

Does Medicare Cover Personal Care Services?

When the only care you need is personal care services, Medicare considers this custodial and doesn’t pay for these services. Personal or custodial care includes needing assistance with simple life tasks such as using the bathroom, getting dressed, or bathing.

What are the Qualifications for Medicare Covered Home Health Care?

The qualifications for Medicare to cover home health care are as follows.

  • You’re under the supervision of a professional that reviews your treatment plan frequently
  • The doctor certifies that you need skilled nursing care or other forms of therapy
  • Your doctor confirms that you’re homebound
  • You only need speech, physical, or occupational treatment on a short-term basis
  • Skilled nursing is only intermittent or part-time
  • Medicare must approve the home health agency used

After meeting all conditions, beneficiaries typically don’t pay for in-home care.

Do Medicare Advantage Plans Cover Home Health Care?

Very recently, advantage plans are allowing coverage for a range of in-home care services. Although only 3% of policies offer in-home support like personal care and housekeeping.

However, new supplemental benefits are now an option, just on a bigger scale. About 13% of plans cover family caregiver support like respite care and counseling.

Times are changing, and in-home care is necessary for many seniors in the U.S. As the baby boomer population grows into retirement, more people need in-home care.

How to Get Help with Medicare Coverage for In-Home Caregivers

At some point, you may need services that require home healthcare insurance. If you need help with coverage, you've come to the right place. Some beneficiaries may qualify for the PACE program, and other social services help drive programs to provide community care to low-income Americans.

As seniors, you still have many choices, and we can help you find the right option for your health care needs and budget. We can help answer your questions and get you rates from all the top companies without you needing to call each top company individually. Give one of our agents a call today at the number above or fill out our online rate form today. You're just a phone call away from your policy match!

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Lindsay Malzone

Lindsay Malzone is the Medicare expert for MedicareFAQ. She has been working in the Medicare industry since 2017. She is featured in many publications as well as writes regularly for other expert columns regarding Medicare. You can also find her over on our Medicare Channel on YouTube as well as contributing to our Medicare Community on Facebook.

2 thoughts on “Does Medicare Cover Home Health Care

  1. Hi Lindsay, my mother in law suffered a major stroke very recently and we are looking to decide what Medicare plan is best for her. We still do not know what treatment will be required or the full impact of her stroke. At what point should we be making decisions on what plan to subscribe to? What information should we have in hand from her doctors before making this decision?

    1. Hi Adam! I’m sorry to hear about your mother, I’m happy she has someone to help her recover. I need a little more information to help guide you in the right direction. Does your mother have any parts of Medicare now? (Part A, Part B, Part D, or Medicare Advantage) When was your mother first eligible for Medicare? This will help us determine if she is in an open enrollment period to enroll in anything at the moment. If she missed her Initial Enrollment Period to enroll in Part A and Part B, the General Enrollment Period is now and ends March 31st. However, her benefits won’t become active until July 1st. If she does already have Part B, I would need to know her active date. That will help us determine if she can still enroll in a Medigap plan without her pre-existing condition impacting her being accepted into the plan. I would recommend giving us a call so that an agent can collect all the information needed to get you on the right track.


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