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Does Medicare Cover My Home Care Needs?

Medicare in-home healthcare services

Does Medicare Cover My Home Care Needs?

There are many misconceptions about what Medicare will cover and how to qualify for it. Medicare only covers limited home care under certain strict conditions. When these conditions are met, Medicare can cover the in-home care needed by you or your loved one for significantly reduced costs, and, in some cases, care is completely free.

How do you qualify for Medicare?

There are several different Medicare plans: Medicare Plan A, Medicare Plan B, and Medicare Plan C Medicare Advantage.

  • Medicare Plan A and Medicare Plan B cover limited home care with the same requirements, except Plan A requires that the care follow a minimum of a three-day hospital visit, while Plan B requires no hospitalization to qualify. Other conditions include:
    • Under the care of a doctor and getting services under a plan of care that is regularly reviewed by the doctor.
    • Has a medical need for or has been prescribed by a doctor intermittent, skilled nursing care or rehabilitative physical or speech therapy. Skilled nursing care means that the needed services are complex enough that only a qualified nurse can complete them. For example, injections, tube feedings, catheter changes, observation of a condition, and wound care.
    • Services are needed only part-time to recover from an injury, illness or condition that is expected to improve in a reasonable and generally predictable amount of time.
    • Confined to the home, meaning it is either 1) difficult to leave home, or 2) additional assistance from another person or medical device is needed to leave home.
    • Care is provided by a Medicare-certified home care agency. Independent caregivers, private therapists, and registry nurses are not covered by Medicare.
  • Medicare Plan C Medicare Advantage may provide coverage even if not all of the qualifications for Plan A or Plan B are met. To find out if Medicare Plan C covers the needs of you or your loved one, it is best to contact your plan directly.

What Does Medicare Cover?

A common misconception is that Medicare covers long-term home care. In reality, Medicare only covers limited, part-time home care. This includes:

  • Intermittent skilled nursing or rehabilitation care while recovering from an injury, illness, or condition. “Intermittent” can mean up to seven days a week for no more than eight hours per day and 28 hours per week.
  • Medical supplies and equipment.
  • Physical and speech therapy.

If you or your loved one qualify for Medicare with these needs, Medicare may also cover:

  • Limited personal care from an agency.
  • An occupational therapist.

Medicare will generally not cover:
  • Nonmedical home care and assistance, such as help with eating, dressing, and housekeeping.
  • Meals delivered to your home.
  • Full-time or 24-hour home care.
  • Personal care or homemaker services.

What Does Medicare Pay For?

Medicare Plan A and Medicare Plan B pay for full charges of the home care agency and 80% of rental costs for durable medical equipment (such as wheelchairs). Medicare Plan C or a Medigap insurance policy will cover full charges of the home care agency, and may cover the remaining 20% of rental costs for durable medical equipment.

The first step, is to talk to your doctor about Medicare and your family’s options. Further questions about Medicare qualifications, coverage, and billing should be directed to 1-800-MEDICARE.

Have a question about Medicare? Our home care experts can help: call us today at 434-455-6500!

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