does medicare cover care at home

When an aging loved one needs help, the goal is often to keep them comfortable and safe in their own home for as long as possible. This leads many families to a crucial question: does Medicare cover care at home? The answer isn’t a simple yes or no, but understanding the rules can help you navigate the options available. Medicare does provide coverage for specific types of in-home care, but it’s important to know the strict criteria that must be met.

When Medicare Says Yes to Home Health Care

Original Medicare (Parts A and B) will cover home health care under certain conditions. To qualify, you must be under a doctor’s care, and your doctor must create a plan that requires skilled services. This means you need intermittent skilled nursing care, physical therapy, speech-language pathology, or continued occupational therapy. You must also be certified as “homebound,” which means leaving your home requires a considerable and taxing effort. When these conditions are met, Medicare can cover skilled nursing care and therapy services for a limited time.

What Kind of Help Can You Expect at Home?

If you meet the eligibility requirements, Medicare-covered home health care includes part-time skilled nursing care and therapies. A home health aide may also be covered if you require hands-on help with personal care activities like bathing or using the bathroom, but only if you are also receiving skilled nursing or therapy services. Importantly, this aide care is part-time and intermittent, not full-time. The agency providing the care must also be Medicare-certified.

Clearing Up Common Misconceptions

One of the biggest points of confusion involves custodial care. This is the non-medical, long-term help with daily activities like dressing, meal preparation, and companionship. Medicare does not cover custodial care if it’s the only kind of care you need. This is a critical distinction and a common reason for denied claims. For long-term daily assistance, families often need to look at other options like long-term care insurance, Medicaid, or private pay.

Your Next Steps for Getting Coverage

The first and most important step is to talk with your doctor. Since a doctor must certify that you need skilled care and are homebound, their assessment is the gateway to coverage. You can also contact your local State Health Insurance Assistance Program (SHIP) for free, personalized counseling on your Medicare benefits and options for care at home.

Navigating home care coverage can feel complex, but knowing the rules is the first step toward getting the support your family needs. By understanding what Medicare does and does not cover, you can make informed decisions and explore all available resources.