Does Medicare Cover Caregiving Costs at Home?
According to a survey conducted in the United States, 90 percent of seniors would rather receive care in their own homes than live in a nursing home. Most of these seniors’ families also prefer paying for trained caregivers to assist their loved ones at home with daily activities, health care, and social needs rather than the alternative.
Some of the reasons the people who were surveyed prefer getting professional home caregiving help include:
- Better quality of life for the patient
- Difficulty caring for a parent with dementia
- Family caregivers need help from trained caregivers
- Better health, faster healing or recovery, and extended life of the patient
- More independence for the patient
- Having the comfort of home for the patient, family, and friends
Caregiving services include assistance with activities of daily living (ADLs) like getting into or out of bed, getting dressed, personal hygiene, shopping, meal preparation, cleaning, transportation, taking medications, caring for wounds, and others.
If you, or someone you’re caring for needs home services, you may be concerned about whether Medicare helps you cover the costs. Medicare covers some services you get at home, but it doesn’t cover all care. Here’s a look at what’s included in Medicare benefits.
Does Medicare cover caregiving costs at home?
If you are homebound, Original Medicare Parts A (hospital insurance) and B (medical insurance) cover some home health care services if you require skilled care on an intermittent or part-time basis. If you need full-time care, you may not be able to get Medicare coverage.
To be eligible for these benefits as a homebound beneficiary you must meet any of the following conditions:
- You have difficulty leaving your home without the assistance of a cane, wheelchair, walker, crutches, help from another person, or help from special transport due to illness or injury.
- Your health care provider recommends that you don’t leave your home based on your health condition.
- You can’t leave your home because of the effort involved.
Furthermore, you must have an in-person visit with a health care provider who can certify your need for home health care services. The health care provider who orders your home care must accept Medicare assignment, and your care must be provided by a Medicare-affiliated home health agency.
Medicare covers the following home health care services:
- Part-time or intermittent skilled care that is certified as medically necessary. Medicare defines part-time or intermittent as being up to eight hours per day and no more than 28 hours each week. Medicare may cover more frequent care on a short-term basis if your health care provider certifies its necessity.
- Physical, occupational, and/or speech-language pathology therapy
- Medical social services
- Care from a home health aide on a part-time or intermittent basis if you’re getting skilled nursing care simultaneously
- Injectable osteoporosis drugs (for women)
- Durable medical equipment (Medicare Part B)
- Medical supplies you use at home (Medicare Part B)
Original Medicare Parts A and B won’t cover the following caregiving services at home:
- Around-the-clock care in your home
- Delivered meals
- Homemaking services that are unrelated to your care plan
- Custodial care such as bathing, using the bathroom, eating, etc. if it is the only type of care you need.
Original Medicare Part A pays 100 percent of the costs for home health care services it covers. Original Medicare Part B pays 80 percent of the costs for durable medical equipment and medical supplies you use at home. You pay the remaining 20 percent after meeting your annual Part B deductible.
If you are enrolled in a Medicare Advantage (Part C) plan, you are guaranteed to receive, at minimum, all benefits provided by Original Medicare Parts A and B. Today, most Part C plans also provide additional coverage and extra benefits, so your provider might offer more coverage for home health care services. If you aren’t sure what benefits you’re entitled to, you should call your provider for details.