Does Medicare Cover At-Home Care? Understanding Your Options

Navigating health care options as we age can be complicated, particularly when it comes to affording the services we need. One common question is whether Medicare covers home care services. This guide breaks down what you need to know about Medicare and its home care coverage.

What Home Care Involves

Home care refers to a range of services provided to individuals in their own homes. These services can include medical assistance, such as nursing care or therapy, as well as nonmedical care, like help with daily activities such as bathing, dressing, or meal preparation. Home care is often preferred by individuals who want to age in place while receiving the support they need.

Many seniors prefer aging in place over moving to assisted living facilities. If your senior loved one needs assistance to remain safe and comfortable while living at home, reach out to Rainbow Home Care, a leading senior home care agency. Our dedicated in-home caregivers can assist with meal prep, bathing and grooming, exercise, medication reminders, and many other important tasks.

Types of Home Care Services Covered by Medicare

Medicare does cover certain home care services, but there are limitations. The main services covered fall under the Medicare Part A and Part B umbrella, and they’re typically related to medical needs. Some examples include:

• Skilled nursing care - Medicare will cover part-time or intermittent care provided by a licensed nurse for a patient recovering from surgery or illness. Examples include medication administration or wound care.

• Physical, occupational, and speech therapy - If a doctor determines therapy is medically necessary, Medicare may cover sessions that restore physical function, enhance speech, or adapt daily tasks.

• Medical social services - Counseling and social work related to managing a health condition or connecting with resources can also fall under Medicare’s coverage.

• Home health aide services - Limited coverage is available for personal care assistance, but only if it accompanies skilled nursing care.

The type of homecare Santa Ana seniors need can vary. Some need assistance a few hours a day, while others require more extensive around-the-clock assistance. At Rainbow Home Care, we tailor our care plans based on each senior’s individual care needs, and the plans can be adjusted at any time. 

Eligibility for Medicare’s Home Care Coverage

To qualify for Medicare-covered home care, certain conditions must be met. These include:

• Doctor’s certification - A doctor must certify you need specific skilled services, such as nursing care or therapy, and that you’re housebound (unable to leave your house without significant effort).

• Care from a Medicare-certified agency - The home health care services must be provided by an agency approved by Medicare.

• Intermittent care requirement - Home care services must be part-time or intermittent rather than around-the-clock care.

Medicare doesn’t cover long-term care or custodial care (help with daily activities like laundry or cleaning) unless it’s part of medically necessary care.

Services Not Covered by Medicare

Though Medicare offers some home care coverage, many services aren’t included:

• 24/7 care at home - Continuous care, whether for medical or personal needs, falls outside Medicare offerings.

• General custodial care - Help with daily tasks like bathing, dressing, and cooking isn’t covered unless they accompany specific medical services.

• Homemaker services - Cleaning, laundry, and other household chores are also not typically covered.

• Meal delivery - While some state programs provide meal delivery to seniors, Medicare doesn’t include this service in its benefits.

Considering Other Options for Home Care Coverage

If your home care needs fall outside what Medicare covers, there are other resources you can explore:

• Medicaid - For individuals who qualify, Medicaid offers more comprehensive home care coverage than Medicare, including long-term and custodial care.

• Long-term care insurance - Policies specifically designed for extended care services often include provisions for home care.

• Private pay or nonprofit assistance - Many families pay for uncovered care out of pocket, while some nonprofit organizations offer assistance for seniors needing home care.

There are a variety of age-related health conditions that can make it more challenging for seniors to live independently. However, many of the challenges they face can be easier to manage if their families opt for professional in-home care. Santa Ana families can rely on expertly trained caregivers to keep their loved ones safe and comfortable while aging in place. If you need professional care for your loved one, reach out to one of our Care Managers today.