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What in-home care will Medicare cover?

The in-home care that Medicare will cover depends on the type of care involved.

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.

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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.

[hio_question question="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.

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Robert Harding
11 months ago

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

Admin
11 months ago
Reply to  Robert Harding

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

JENNY REED
7 months 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
11 months ago

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

Josh Schultz
11 months 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
8 months 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
8 months 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
8 months 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

Admin
Josh Schultz
8 months 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
7 months 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
3 months 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
6 months 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
3 months 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
6 months 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
3 months 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
5 months ago

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

Admin
Josh Schultz
5 months 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?

Vicki Barbero
5 months 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
3 months 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
5 months 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
3 months ago
Reply to  Char

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

Pam
4 months 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
4 months 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
4 months 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
4 months 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
4 months 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
4 months 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
4 months 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
4 months 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
3 months 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
3 months 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
3 months 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
3 months 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
3 months 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 months 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
3 months 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 months 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 months 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 months 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 months 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 months 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.

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