- Medicare typically doesn’t pay for in-home caregivers for personal care or housekeeping if that’s the only care you need.
- Medicare may pay for short-term caregivers if you also need medical care to recover from surgery, an illness, or an injury.
- Medicare pays for short-term home health services like skilled nursing care, physical therapy, or occupational therapy if you’re homebound and your doctor orders it.
If you have a medical condition that makes it harder to get out and about, home healthcare may be a more convenient, less expensive, and effective way for you to get the care you need.
From time to time, original Medicare (Part A and Part B) may cover medical care given to you in your home if you’re homebound. Medicare may also pay for some in-home assistance with your daily needs for a short period following an illness or injury.
But if you need long-term help with daily activities in your home, it’s important to know that Medicare typically doesn’t cover those caregiving services.
Whether Medicare pays for in-home caregivers depends on the kind of care you’re receiving, the reason you need care, and the length of time you’re going to need it.
In-home medical care
If you’re homebound because of an illness or injury, you can use Medicare home health benefits if any of the following apply:
- You can’t leave home other than for short outings, such as going to the doctor or to religious services. One exception: You can still receive in-home care if you go to adult day care.
- Your doctor verifies that you need at-home care and writes a plan outlining the care you need.
- You need skilled nursing care (less than 8 hours per day and no more than 28 hours per week, for up to 3 weeks).
- Your doctor thinks your condition is going to improve in a reasonable, or at least predictable, amount of time.
- You need a skilled physical, occupational, or speech therapist to design a program to help you improve, maintain your current state of health, or keep you from getting worse.
- You need a home health aide to help care for you while you recover.
- The home health agency providing your care is Medicare-approved or certified.
To remain eligible for in-home care, you’ll need to see your doctor fewer than 90 days before or 30 days after you start receiving home healthcare services.
Medicare covers many services, some of which may be provided in your home. Here are some services and the Medicare rules that apply to them.
If a physical therapist treats you in your home, Medicare is likely to pay for these kinds of services:
- assessment of your condition
- gait training and exercises to help you recover from surgery, injuries, illnesses, or neurological conditions like stroke
- postoperative wound care
- wound care for injuries, burns, or lesions
If an occupational therapist treats you at home, you can expect to receive these kinds of services:
- help with establishing daily routines for taking medications, planning meals, and taking care of personal needs
- training in strategies to conserve your energy and reduce stress
- teaching you how to carry out daily tasks safely
- helping you regain the ability to function, given your needs and condition
- helping you carry out your doctor’s orders
If a speech therapist works with you in your home, here are some of the services you may receive:
- help remembering or recognizing words
- therapy to help you regain the ability to swallow
- therapy to help you eat and drink as normally as you can
- education about alternative ways to communicate if you cannot speak
- education about new ways to communicate if you’ve lost your hearing
If a registered nurse or licensed practical nurse comes into your home to care for you, they may:
- change your wound dressings
- change your catheter
- inject medications
- carry out tube feedings
- administer IV drugs
- educate you about how to take your medications and care for yourself
Home health aides
Home health aides, on the other hand, are likely to help you with these kinds of services:
- monitoring your vital signs, such as heart rate, blood pressure, and body temperature
- making sure you’re taking your medications the way you should
- evaluating whether your home is safe for you, given your needs and condition
- checking that you’re eating and drinking in a healthy way
You may also be eligible for in-home social services. If you qualify, you may get help finding resources in your community to help you adjust to your condition. You may also receive social, emotional, or psychological counseling related to your condition.
Medicare doesn’t typically cover caregivers who help you with the activities of daily living, unless it’s necessary for a short period of time while you recover from an illness or injury.
Custodial care generally includes services like meal delivery or preparation, shopping, laundry, housekeeping or cleaning, help bathing and dressing, or assistance using the restroom. Medicare won’t pay for a caregiver to provide these services in your home if these are the only services you need.
Medicare also doesn’t pay for:
- 24-hour care in your home
- full-time skilled nursing care
Your home healthcare rights under Medicare
Medicare guarantees you certain rights and benefits. You have the right:
- to choose your home health provider
- to have your belongings and your home treated with respect
- to get a written copy of your health plan
- to make your own healthcare decisions
- to know if your care plan is changing
- to have your privacy protected
- to choose a family member or representative to make decisions if you’re unable to make them for yourself
- to be informed (in writing) of what your costs are going to be
- to contact the home health hotline to report fraud or abuse
- to get written information about how to appeal Medicare decisions and how to report fraud or abuse
A 2019 industry survey on home health costs found that a home health aide is likely to cost an average of $4,385 per month. The same survey listed the average monthly cost of a caregiver to provide custodial care services as $4,290.
If you or your loved one have exhausted your financial resources paying for in-home caregivers, you may be eligible for both Medicare and Medicaid.
Every state has at least one home- and community-based health services waiver program. If you meet the eligibility guidelines, this type of waiver program could help you pay for things like:
- adult day care
- housekeeping services
- help with daily personal care
- modifications to your home
- help with housekeeping
If you think you or someone in your family might need custodial care, you may want to consider a long-term care insurance policy to help you cover the cost.
A Medicare supplement (Medigap) plan may also help you pay some of the costs that Medicare won’t cover.
Medicare Part A is hospital coverage. If you were admitted to the hospital for 3 consecutive days or Medicare covered your stay in a skilled nursing facility, Part A will cover home healthcare for 100 days, as long as you receive home health services within 14 days of leaving the hospital or nursing facility.
Medicare Part B is medical coverage. If you need home health services but weren’t admitted to the hospital first, Part B covers your home healthcare. You do have to meet the other eligibility requirements, though.
Part C (Medicare Advantage)
These plans provide the same basic coverage as original Medicare, but they’re run by private insurers.
Medicare Part C (Medicare Advantage) plans may require you to get home healthcare from an agency in the plan’s provider network. Check with your plan for details.
Medicare Part D plans are also private insurance plans. They cover some or all of the costs of the prescription drugs you may need during your home healthcare period.
Medicare supplement (Medigap)
Like Part C and Part D plans, Medigap policies are offered by private insurance companies. They may help you pay the costs of home healthcare that Medicare doesn’t cover.
If you want to research certified agencies in your area, Medicare has a tool to help you find a home health agency. Once you locate an agency near you, you can use Medicare’s home health agency checklist to determine whether the agency will provide the level of care you want.
Your state survey agency keeps an up-to-date report on the quality of care given by home healthcare providers. You can check Medicare’s resource guide or survey agency directory to find the telephone number or email address of the agency in your state.
Medicare only lets you receive care from one home health agency at a time. If you decide to change which agency you use, you will need a new referral from your doctor. You will also need to inform your old agency that you’re switching providers.
Medicare doesn’t pay for an in-home caregiver when custodial care services like housekeeping and personal care are all you need. Medicare may pay for some short-term custodial care if it’s medically necessary and your doctor certifies that you’re homebound.
Medicare does pay for home health services like physical therapy, occupational therapy, speech therapy, skilled nursing care, and social services if you’re homebound after surgery, an illness, or an injury.
Your doctor will need to certify that the services are medically necessary, and your home health agency must be Medicare-certified.
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