Since 2011, we've helped more than 5 million people understand their Medicare coverage.

Find Medicare plans that fit your needs.*

Get coverage now!

What in-home care will Medicare cover?

Maurie Backman // August 25, 2022

Related articles

Will Medicare cover the cost of wheelchairs and walkers?

Will Medicare cover the cost of wheelchairs and walkers?

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.

How can I find a Medicare-assigned store to purchase an upright walker?

How can I find a Medicare-assigned store to purchase an upright walker?

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.

How does a doctor’s participation in Medicare affect reimbursement?

How does a doctor’s participation in Medicare affect reimbursement?

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.

Four ways to adjust your Medicare coverage

Four ways to adjust your Medicare coverage

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.

Important Medicare enrollment dates

Important Medicare enrollment dates

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: 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.

Today's Medicare Poll

medicare-poll

Did you take advantage of the Medicare Advantage Open Enrollment Period?

No, I did not make any changes during the MAOEP.
70.5%
Yes, I switched to a different Medicare Advantage plan.
23.1%
Yes, I switched to Original Medicare.
6.4%
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.

Will Medicare cover skilled nursing care?

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.

Will Medicare cover physical, occupational, and speech therapy?

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.

Does Medicare cover durable medical equipment?

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.

Does Medicare cover medical social services?

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.

Who’s eligible for in-home care through Medicare?

Medicare enrollees are eligible for in-home care under Medicare Parts A and B provided the following conditions are met:

  • The patient is under the care of a doctor who reviews his or her treatment plan regularly.
  • A doctor has certified that the patient needs skilled nursing care or some type of therapy.
  • The patient only needs physical, speech, or occupational therapy for a limited period of time.
  • A doctor has certified that the patient is homebound.
  • The need for skilled nursing is only part-time or intermittent.
  • The home health agency used to provide care is approved by Medicare.

Additionally, other than durable medical care, patients usually don’t pay anything for in-home care.

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.

Will Medicaid pay for long-term care services?

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.

0 0 votes
Article Rating
Subscribe
Notify of
53 Comments
Oldest
Newest Most Voted
Inline Feedbacks
View all comments
Robert Harding
2 years ago

24/7 financial assistance for two elderly 85/92 married senior. 85 year male is a Veteran.

Admin
2 years ago
Reply to  Robert Harding

Robert, I’m not certain what you’re asking for here. Can you be more specific?

Robert Collins
1 year ago
Reply to  Steve Anderson

I am 74 years old and 100% disabled. I have difficulty with custodial care such as cleaning, shopping, laundry. I have difficulty walking and carrying any objects, and maintaining balance

Editor
1 year ago
Reply to  Robert Collins

You should look into whether you qualify for Medicaid, which could pay for some of those services. Here is more information about Medicaid in each state: https://www.medicareresources.org/financial-help-by-state/

JENNY REED
2 years ago
Reply to  Robert Harding

Mr. Harding, I would call a local Veteran Service Officer, if you are drawing VA disability the VA Has certain programs you may qualify for such as aid and attendance, bathroom made handicap accessible. please call 334 428 2687 and he may can help you find a local veteran service officer. Also, some veteran organizations such as the American Legion, Order of the Purple Heart, VFW have grants you can apply for. Call Department of Human Services in your community for any local programs and assistance. I hope this helps you. Thank you for your service Jenny.

Pat Finn
2 years ago

Can a private PT treat a Medicare patient, at, and bill Medicare with place of service 12 (home).

Josh Schultz
2 years ago
Reply to  Pat Finn

Medicare will cover physical therapy that is provided in the home through the home health benefit. You mention a “private” physical therapist — Medicare will only pay for care from Medicare-enrolled providers, and there are network limitations if the patient has Medicare Advantage.

Nancy garin
2 years ago

I am going to have same day hip surgery. Will Medicare pay for in-home health help and in-home physical therapy

Maurie Backman
2 years ago
Reply to  Nancy garin

If a doctor has certified that you need in-home care and physical therapy, then Medicare should pick up the tab for in-home care. You’ll need to use a provider that’s approved by Medicare for this service to be covered.

Pat OToole
2 years ago

My sister needs to have physical therapy due to a broken leg. She was getting skilled nursing at Prairie Vista in Altoona. She was discharged from there on May 6. She is currently staying with a sister in Altoona. The goal is for her to go to her home in Marshalltown with someone to come in to give her physical therapy and help her with her diabetes meds. She is currently using a walker to get around. Could you give me some recommendations to call for assistance in the Marshalltown area. Thanks, Pat OToole

Josh Schultz
2 years ago
Reply to  Pat OToole

Hi Pat,

You might try looking on Medicare.gov for a home health agency. It may be hard, though, to find care right now due to the coronavirus. But I believe some providers are seeking patients for in-person visits.

https://www.medicare.gov/homehealthcompare/search.html

Michelle
2 years ago

My father has altzheimers and had a stroke so he can’t drive, but is a vet. Recently my mother got diagnosed with CHF and just got released from the hospital but cannot go back to caring for him full time… the are both mid 80’s. Suggestions on in home care options to help so she can get rest?

Maurie Backman
2 years ago
Reply to  Michelle

You may be eligible for skilled nursing or in-home therapy to help your father recover from his stroke. Medicare will generally pay for these services so it’s worth consulting with your father’s physician and seeing what care would best work for him and your family. If you wind up needing a home health aide to assist with everyday living, that may not be a Medicare-eligible expense, but if the care relates to the recovery of his stroke, there’s a better chance of Medicare picking up some of the tab.

Bret
2 years ago

I have lost all short term memory will Medicare help with in home care or do I need to be in a home

Maurie Backman
2 years ago
Reply to  Bret

Ultimately, only a medical professional can determine whether it’s safe for you to live at home or not. I would suggest consulting with a doctor and seeing what he or she recommends. If your memory loss is related to an injury or procedure then you may be eligible for therapy or nursing assistance in your home.

Joanie
2 years ago

My husband is too weak to get off the floor after falling into his power chair. He is about 230 lbs and it is difficult for me to get him up. Is there help for this anywhere?

Maurie Backman
2 years ago
Reply to  Joanie

For Medicare to provide in-home care, you’ll generally need a medical professional to certify to the fact that your husband needs skilled nursing care or therapy related to a specific condition, surgery, or illness. But your husband may be eligible for certain durable medical equipment that lend to his mobility. It pays to consult with your doctor and see if there’s a solution here.

Susan Crutchfield
2 years ago

Why does Medicare not pay for in home medical infusion therapy supplies.

Josh Schultz
2 years ago

The 21st Century Cures Act established a new Medicare home infusion therapy benefit beginning January 1, 2021. Here is more information on that: https://www.cms.gov/files/document/se19029.pdf

Are you presently trying to receive home infusion therapy services?

Constance D Timmerman
1 year ago

Husband sent home after 11 day hospital stay. He is battling a rare bacterial infection from a pacemaker replacement. Est. 6-8 wks or more on 2 iv drips. Our copay runs 752.00 per wk and that jumped to 1152. This covers co-pay and inhome supplies. Why is Medicare not paying when had he stayed in hospital for months,everything would be covered. This is crazy when I’m doing all The work so he could come home

Vicki Barbero
2 years ago

My mother has had several falls in past 6 months and cannot be left alone. She is homebound and needs help with daily living tasks. She lives in Connecticut. Is she eligible for in home care

Maurie Backman
2 years ago
Reply to  Vicki Barbero

If the care your mother needs is custodial in nature, then Medicare probably will not pay for her care, unfortunately. However, if a medical professional can certify to the fact that she needs nursing care or care related to a specific injury, then she may be eligible. Your best bet is to work with your mother’s doctors and see what comes of it.

Char
2 years ago

My husband has Parkinson’s disease, he will not except care from strangers. I care for him before, during and after my workday. Can I get paid to care for him every day?

Maurie Backman
2 years ago
Reply to  Char

Unfortunately, Medicare won’t pay you to care for a family member.

Pam
2 years ago

Hi! My mother is currently in an assisted living facility. She has COPD congestive heart failure and emphysema. She has low blood oxygen levels frequently and has to go to the emergency room frequently to get her levels back to normal. She also has dementia. We are waiting for a memory care unit to open up here and until the she is requiring 24 hour sitter service. Does Medicare help cover something like that? I am confused with all this. She also has a supplemental insurance through her former employer. thank you

Josh Schultz
2 years ago
Reply to  Pam

Hi Pam,

I am sorry to hear about your mother’s situation. Unfortunately, Medicare does not cover things like a memory care unit. It sounds like your mother should consider applying for Medicaid — which does cover long-term care.

JOE KELLY
2 years ago

My wife recently qualified for Medicare. Drawing social security since 62and a half She was automatically enrolled. Being recently diagnosed with Alzheimer’s, who do I contact to see about the 28 to 35 hours of care that she may qualify for. Thank you

MAURIE BACKMAN
2 years ago
Reply to  JOE KELLY

You can call (1-800-633-4227) for more information, but if you have a Medicare Advantage plan, I would recommend reaching out to your specific plan administrator for further detail. You can also consult this guide for more information on home care: https://www.medicare.gov/Pubs/pdf/10969-Medicare-and-Home-Health-Care.pdf. It’s a longer read but it may help answer some of the questions you have.

Brian
2 years ago

My mother had operation on her neck about 4 MO the ago, and is still confined to wheelchair and at a care facility, she wants 6o come home as need someone to help changing her and bathing, will Medicare pay for this?

Josh Schultz
2 years ago
Reply to  Brian

Unfortunately, Medicare probably will not pay for those services unless your mom also needs ‘skilled care’ — i.e. intermittent nursing care or physical / occupational therapy that is provided at home.

Mercedes
2 years ago

I am having knee replacement surgery. Can medicare pay for my boyfriend to stay home or my daughter in law. They need to work but could take a week off each to take care of me if medicare pays. I will be in a lot of pain an unable to take care of my self for for about two weeks.

MAURIE BACKMAN
2 years ago
Reply to  Mercedes

Medicare unfortunately will not pay for a family member or loved one to take time off of work to care for you. You may want to see if you qualify for skilled nursing care following your surgery, because Medicare will often pay for that as long as it’s deemed medically necessary.

Demeter
2 years ago

How do I find out if my mother who has Alzheimers can qualify for the 35 hours a week in home care?

Maurie Backman
2 years ago
Reply to  Demeter

Reach out to your plan servicer and ask. Each case is assessed on an individual basis so the best way to know what coverage you’re entitled to is to present your unique details. As a general rule, Medicare will pay for up to 100 days of skilled nursing services at home under limited circumstances.

Kate
2 years ago

My mother can not be left alone during the day. She lives with my sister but she works. Will Medicare pay for someone to sit with her during the day. She can’t walk therefore needs help going to the bathroom with a portable toilet.

Maurie Backman
2 years ago
Reply to  Kate

Unfortunately, it sound like your mother needs general custodial care, which is generally not covered by Medicare. If her inability to walk is related to a specific injury, however, then she may be eligible for some care, but that injury would have to be one she could potentially recover from for Medicare to pitch in.

Dawn Mitchell
2 years ago

I am helping take car of my friend’s mom. She has medicare and medical and had surgery on her foot. Needs help doing everything right now. But has no money to pay for help. What can she do?

Editor
2 years ago
Reply to  Dawn Mitchell

Medi-Cal may cover at-home care for her. This page has more information about Medi-Cal benefits: https://www.medicareresources.org/states/california-guide-content/

Jackie Parkey
2 years ago

My mother lives in senior apartments. I live an hour and half away. I go to her house at least 2x week. She is now having difficulty walking. She needs someone to stand by while she takes a shower. She is petrified of falling so most ADLs are becoming very difficult for her. She has Medicare and Mutual of Omaha insurance. If her doctor writes an order will they pay for home health. She does not want to come live with me yet. Thank you

Editor
2 years ago
Reply to  Jackie Parkey

Medicare would cover some home health care if your mother needs intermittent skilled nursing care, physical therapy or occupational therapy that needs to be provided in her home.

The services you’re describing sound like they are more likely to be covered by Medicaid, not Medicare. We have more information about those benefits here: https://www.medicareresources.org/financial-help-by-state/

Claudia
2 years ago

My mom is 94 and has vertigo, a pace maker and is homebound. She lives alone in a condo and does not cook for herself. She receives meals on wheels monday thru friday. She is moving around less and less each day and seem to be weak and tired. Can she get home care assistance from medicare.

Editor
2 years ago
Reply to  Claudia

It sounds like your mom might benefit from assistance through Medicaid, which covers long-term care. Here is more information about that coverage in each state: https://www.medicareresources.org/financial-help-by-state/

Carol
2 years ago

I had surgery and 2 weeks at a SNF. I am now home with a walker in a Miami J collar. Home health did their admissions visit and an OT visit later. I am doing well and with no further assistance needed. They are now coming to me a week later to discharge. Will Medicare pay for them really doing nothing but admitting and then discharging? I do not see Dr and out of collar for another two weeks.

Editor
2 years ago
Reply to  Carol

It sounds like you may have a complaint about the medical care you received. I recommend contacting the health care provider about that.

Amanda
1 year ago

will medicare / medicaid cover daily in home skilled nursing care to a quadriplegic that has daily wound dressing changes, and is total care?

Editor
1 year ago
Reply to  Amanda

Hello Amanda,

Medicaid might cover those services. Here is more information about Medicaid benefits for Medicare beneficiaries:
https://www.medicareresources.org/financial-help-by-state/

Thanks,
Josh

Janine Barnett
1 year ago

My 84 year old mother-in-law fell and broke her hip the end of last year and is living with us now. The doctor has diagnosed her with Lewy body dementia. She fell again last week while my husband was out for 3 hours and no one was with her. Luckily she didn’t brake her hip again but is very sore and intermittently confused. Would we be able to get in-home care for her while we are at work and have it covered by Medicare? She needs help with bathing, transferring to the toilet and couch and needs help with meals. I am an RN and work 3 12 hour shifts per week so would need someone to be with her 2-3 days a week for probably 12 hours.

Last edited 1 year ago by Janine Barnett
Cathy Donovan
1 year ago

My 90.5 yr old mom fell and broke her arm. She is in an independent living facility. Can Medicare provide some assistance with ADLs for a short period of time while she recovers?

Lou
1 year ago

My friend has prostate cancer. He went to a local urologist and that doctor sent him to the big city hospital. He had to have his prostate removed, then have radiation. The radiation made a hole in his urethra. He was to have reconstructive surgery but once they cut him open is when they found the hole. He’s been wearing depends even before he went to the city. We have tried to have Medicare or his supplement. He had to change his depend at least 6 times.a day. They are really expensive when you have to use a lot of them. We can get no help paying for them so we have to buy them out of pocket. We are both senior citizens with a fixe?d income. Would anyone agree that he should get them at a discount or free? We can’t really go anywhere for very long because the leak. He carries some with him but sometimes there’s no where to change. What do you all recommend? Would love to hear your opinion!

Diane selle
1 year ago

My aunt needs someone to give her meds morning and night. She has early dementia. Right now she pays by herself. But would like to see if anything would help because it’s expensive. If someone doesn’t make sure she takes her pills, she’ll hide them and say she took them.

susan
9 months ago

Hello , I am a licensed certified nursing assistant in mass . I take care of a patient who is homebound on hospice care . I would like to be able
to bill the patients medicare for a portion of hours i work weekly . How would i go about doing this . ty

Tammy Blasiak
8 months ago

My parents live in Florida but both need assistance. My father is in last stages of Parkinson’s and needs to be in a Nursing facility now. They have some assets, but we would like to put him in a Nursing home in Michigan where the rest of the family reside. I was told they have to have a Michigan residency in order to qualify for Michigan Medicaid. Is there a time period that would disqualify them to receive Medicaid if we purchased a home for them in MI right away and started the Medicaid process?

Tanya Feke, MD
8 months ago
Reply to  Tammy Blasiak

Every state has different Medicaid eligibility requirements but all of them have a requirement that you live in the state. An application for Medicaid will require proof of residency such as a state-issued ID, mail that has your name and address on it (P.O. boxes do not meet that requirement), and/or other written documentation. I would encourage you to reach out to the Michigan Medicaid office to find out if your father would be considered a resident immediately after he moved to the state or if he needs to live there for a certain number of months before he qualifies. It is important to be clear that he is looking for long-term care with placement in a nursing home and not traditional Medicaid since this could affect the eligibility requirements too.

53
0
Would love your thoughts, please comment.x
()
x