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Since 2011, we've helped more than 5 million visitors understand Medicare coverage.
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We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1–800– MEDICARE to get information on all of your options.
Q: What in-home care will Medicare cover?
A: The in-home care that Medicare will cover depends on the type of care involved, and whether it’s truly medical in nature.
Many seniors require in-home care, but that care isn’t always medical in nature. While Medicare will often pick up the tab for services such as in-home skilled nursing or physical therapy, it generally won’t cover care that’s custodial in nature.
Custodial care refers to supportive care for those who are incapable of managing daily living functions, like dressing, bathing, or preparing food. Medicare will sometimes pay for short-term custodial care (100 days or less) if it’s needed in conjunction with actual in-home medical care prescribed by a doctor. Otherwise, seniors typically need to pay for custodial care themselves. Other types of in-home care, however, are covered by Medicare.
Medicare will pay for what’s considered intermittent nursing services, meaning that care is provided either fewer than seven days a week, or daily for less than eight hours a day, for up to 21 days. Sometimes, Medicare will extend this window if a doctor can provide a precise estimate on when that care will end.
Skilled nursing services are generally required to treat an illness or assist in the recovery of an injury. As the name implies, those who provide this care are licensed to administer medical treatment such as injections, catheter changes, wound dressings, and tube feedings.
The maximum amount of weekly care Medicare will pay for is usually 28 hours, though in some circumstances, it will pay for up to 35. But it won’t cover 24-hour-a-day care.
Medicare will pay for physical therapy when it’s required to help patients regain movement or strength following an injury or illness. Similarly, it will pay for occupational therapy to restore functionality and speech pathology to help patients regain the ability to communicate.
However, Medicare will only pay for these services if the patient’s condition is expected to improve in a reasonable, predictable amount of time, and if the patient truly needs a skilled therapist to administer a maintenance program to treat the injury or illness at hand.
Medicare will cover the cost of medically necessary equipment prescribed by a doctor for in-home use. This includes items such as canes or walkers, wheelchairs, blood sugar monitors, nebulizers, oxygen, and hospital beds. Patients typically pay 20 percent of the Medicare-approved amount for such equipment, as well as any remaining deductible under Part B.
Medicare will pay for medically prescribed services that allow patients to cope with the emotional aftermath of an injury or illness. These may include in-home counseling from a licensed therapist or social worker. Medicare will only cover these services for patients receiving skilled nursing care.
Medicare enrollees are eligible for in-home care under Medicare Parts A and B provided the following conditions are met:
Many seniors require assistance with activities of daily living, as opposed to an actual medical condition. A long-term care policy can help defray the cost of home health aides whose services are strictly custodial in nature. It can also help pay for assisted living facilities, which offer seniors the ability to live independently, albeit with help.
Many Medicare enrollees are qualify for Medicaid due to their limited incomes and assets. Unlike Medicare, Medicaid covers both nursing home care and Home and Community Based Services (HCBS).
Due to the high cost of long-term care, many states have higher Medicaid income limits for long-term care benefits than for other Medicaid coverage. However, Medicaid’s asset limits usually require you to “spend-down” resources before becoming eligible.
Read more here about Medicaid benefits (i.e., Medicare premium assistance and long-term care) available to Medicare enrollees.
Maurie Backman has been writing professionally for well over a decade, and her coverage area runs the gamut from healthcare to personal finance to career advice. Much of her writing these days revolves around retirement and its various components and challenges, including healthcare, Medicare, Social Security, and money management.
Q: Will Medicare cover the cost of wheelchairs and walkers? A: Yes. Medicare Part B covers a portion of the cost for medically-necessary wheelchairs, walkers and other in-home medical equipment (Medicare will not cover power wheelchairs that are only needed for use outside the home). Talk with your doctor about your needs. He or she can write a prescription that can be filled at a designated medical supply company.
Medicare-assigned retailers agree to charge the Medicare-approved price for their products, and can't bill you for anything more than your Medicare deductible and coinsurance.
Medicare reimbursement refers to the payments that hospitals and physicians receive in return for services rendered to Medicare beneficiaries. The reimbursement rates for these services are set by Medicare, and are typically less than the amount billed or the amount that a private insurance company would pay.
If you're like most Medicare enrollees, you probably aren't planning to make any changes to your existing coverage for the coming year, but – like most beneficiaries – you should probably at least consider it during Medicare's open enrollment period. And if you have Medicare Advantage, you also have an opportunity to change your coverage between January and March each year.
Enrollment dates for Medicare are critical. Missing an enrollment date could cost you higher premiums down the line — or it could cost you coverage entirely.
Q: Will Medicare cover the cost of wheelchairs and walkers? A: Yes. Medicare Part B covers a portion of the cost for medically-necessary wheelchairs, walkers and other in-home medical equipment (Medicare will not cover power wheelchairs that are only needed for use outside the home). Talk with your doctor about your needs. He or she can write a prescription that can be filled at a designated medical supply company.
Medicare-assigned retailers agree to charge the Medicare-approved price for their products, and can't bill you for anything more than your Medicare deductible and coinsurance.
Medicare reimbursement refers to the payments that hospitals and physicians receive in return for services rendered to Medicare beneficiaries. The reimbursement rates for these services are set by Medicare, and are typically less than the amount billed or the amount that a private insurance company would pay.
If you're like most Medicare enrollees, you probably aren't planning to make any changes to your existing coverage for the coming year, but – like most beneficiaries – you should probably at least consider it during Medicare's open enrollment period. And if you have Medicare Advantage, you also have an opportunity to change your coverage between January and March each year.
Enrollment dates for Medicare are critical. Missing an enrollment date could cost you higher premiums down the line — or it could cost you coverage entirely.
