Medicare does not pay for home health care for older adults if personal care and cleaning are the only necessary services. Depending on your circumstances, Medicare may pay for your in-home medical care if you:

  • Require medical attention to recuperate after a procedure, a disease, or an injury; Medicare may pay for temporary caretakers.
  • If your doctor authorizes short-term home health treatments such as physical therapy, skilled nursing, or occupational therapy and you are homebound, Medicare will pay for them.
  • Home healthcare may be a more practical, affordable, and effective choice to receive the care you require if your medical condition makes it impossible for you to leave the house.

Original Medicare (Part A & Part B) may occasionally fund house healthcare if you are homebound. After sickness or accident, Medicare may also pay for particular in-home support with daily tasks.

It’s important to realize that Medicare does typically not pay for caregiver services if you need ongoing support with everyday tasks at home.

Does Medicare cover home health care services for older adults?

The kind of care provided, the duration, and the necessity are all factors affecting whether Medicare will reimburse in-home caregivers.

How to get home health care for older adults?

You might qualify for Medicare home health benefits if you fit each of the following requirements and are recovering at home as a result of a disease or injury:

  • You may leave the house for brief outings, such as medical appointments or religious events. One exception is that you may still receive in-home care if you attend adult daycare.
  • Your doctor creates a plan outlining the required services after confirming that you need in-home care.
  • You need specific nursing care (less than 8 hours per day and no more than 28 hours per week for three weeks).
  • Your doctor predicts your condition will improve in a fair amount of time, if not immediately.
  • You need the help of a qualified physical, occupational, or speech therapist to create a program that will help you get well, keep your health where it is, or stop it from getting worse.
  • To aid in your recovery, you will require a home health aide.
  • Your care is being delivered by a home healthcare company that Medicare has approved or certified.
  • You must visit your doctor no more than 90 days before or 30 days after starting home healthcare services to preserve your eligibility for in-home care.

What services qualify for home health care coverage for older adults?

Numerous services that Medicare covers can be obtained at the convenience of your home. The following services are provided, along with the relevant Medicare regulations.

Medicare Only Covers Home Health Care for older adults in Certain Situations

If a doctor has prescribed home health care for housebound older adults, Medicare will pay for it. General personal care can be included in care services; however, home health aides can only be employed part-time, for a maximum of eight hours per day and a total of 28 hours per week.

Medicare Advantage’s supplemental program might provide excellent assistance, while various insurers set guidelines for what extra coverage to offer.

Some Home Health Care for older adults Costs May Be Covered by Medicaid and State Waivers

Seniors with incomes at or below 133% of the Federal Poverty Line may also be eligible for Medicaid-covered home health care if it is medically essential. In Medicaid Home and Community Based Services waivers, home health care is frequently included. These are managed at the state level; therefore, seniors should confirm what services are covered by available releases with the state’s providers.

Seniors with private health insurance can discover that their policies only partially cover home health care. Most private insurance policies only partially or not at all pay for non-medical home care, but they do pay for expert in-home care. For this reason, it’s crucial to read policy documents thoroughly and make a strategy for paying for long-term care for seniors.

Does Medicare pay for necessary home health care for older adult services?

If a senior merely need non-medical home care aids, Medicare typically does not reimburse the cost of those services. However, a senior who needs part-time Medicare aid with the cost of home health care for seniors and is housebound or needs physiotherapy, occupational health support, or other medical assistance in the home.

Medicare entirely covers part-time home health services. Less than eight hours per day for 21 days is considered part-time, as is working less than seven days per week. To be eligible for in-home health care benefits under original Medicare, an individual must have a diagnosis and a proper prescription from a registered medical professional. It’s crucial to research local home health service prices before selecting a provider because all home health services must be economically priced and prescribed by a doctor.

Medicare Advantage might provide more thorough coverage.

Private insurance firms manage Medicare Advantage. These businesses are subject to Medicare regulation and must offer the same fundamental level of protection as Original Medicare. However, they also provide “supplemental health care benefits,” supplementary coverage.

These benefits can be utilized to pay for medical services or equipment that could lower harm risk, lessen the effects of lost mobility or damage, or assist a person in maintaining their health and independence.

Many services not covered by original Medicare are covered under Medicare Advantage. Medicare Advantage customers should get in touch with their insurers to explore their alternatives before choosing a care plan because individual insurers are allowed to use their discretion when deciding what services to offer as supplemental benefits.

What types of home healthcare services am I eligible for?

Medicare provides coverage for a wide range of services, some of which can be obtained in the comfort of your own home. The following are some services and the Medicare rules and regulations that apply to them.

Orthopedic treatment

Medicare probably covers the following services if you undergo physical therapy at home:

  • An assessment of your health
  • Exercises and gait training can aid rehabilitation following surgery, an accident, a sickness, or a neurological disorder like a stroke.
  • postoperative wound care
  • Burns, abrasions, and lesion wound care
  • occupational therapy and counseling

If you decide to have an occupational therapist come to your house, you may count on getting the following treatments:

  • Assistance in developing daily routines for taking medications, planning meals, and taking care of oneself
  • teaching about energy-saving and stress-reduction methods
  • teaching you how to carry out safety-conscious daily duties
  • helping you regain your ability to function in light of your requirements and situations.
  • Assisting you in following your doctor’s instructions

Treatment for the tongue

You could receive the following services if you work with a speech therapist in your home:

  • Assistance with word recognition or word recall
  • therapy to improve your capacity to swallow
  • You will receive therapy to help you eat and drink as normally as possible.
  • If you can’t communicate verbally, get information about other forms of communication.
  • Advice on how to communicate in different ways if you’ve lost your hearing
  • Administering home health care aids for seniors

If a registered or licensed nurse comes to your house to provide care, the following may occur:

  • Refresh the bandages on your wounds.
  • Change the catheter.
  • Administering medicine through injection
  • Feed through a tube
  • Administering drugs via IV
  • Teach you how to take your medications and care for yourself.

The following services, however, are more frequently provided by home health aides:

  • Keep monitoring your heart rate, blood pressure, and body temperature.
  • Make sure you are taking your meds as directed.
  • Evaluate the safety of your home in the context of your requirements and circumstances.
  • Observing healthy eating and drinking practices

Further services

You can also become eligible for in-home social assistance. If you are qualified, you might get help finding community services to help you cope with your condition. You could also get counseling if you need it for social, emotional, or psychological reasons.

home health care for seniors

How much do home health care services cost for older adults?

A 2019 survey of the industry found that a home health aide costs an average of $4,385 per month. According to the same report, the typical monthly cost of custodial care services is $4,290.

Which Medicare parts offer home health care for older adults?

Part A

Medicare Hospitalization is covered in Part A. As long as you obtain home healthcare services within 14 days after leaving the hospital or nursing facility, Part A will pay for 100 days of treatment if you are hospitalized for three consecutive days or if Medicare will pay for your stay in a nursing home.

Part B

Medicare Part B offers health insurance. Part B will cover your expenditures if you need in-home health care but have not yet been admitted to the hospital. It would be best to fulfill all other qualifying requirements to obtain coverage.

Part C (Medicare Advantage)

Private insurers handle the administration of these plans, but they provide the same fundamental benefits as Original Medicare.

You might be required to use home healthcare services from a provider network organization if you have one of the Medicare Part C (Medicare Advantage) plans. Check your plan for details.

It’s important to note that Medicare Part D Plans are still considered private insurance while being a part of Medicare. When you receive medical care at home, they will cover the whole or partial cost of any medications your doctor prescribes.

Insurance Supplement (Medigap)

Private insurance firms sell Medigap plans like Part C and Part D plans. They could possibly assist you in meeting the costs of home healthcare that Medicare does not cover.

The Key Points

Medicare does not cover an in-home caregiver if you just need custodial care services, such as housekeeping and personal care. If your doctor issues a certificate stating you are homebound, it can cover some short-term custodial care.

Suppose you are confined to your home due to surgery, sickness, or injury. In that case, Medicare also provides coverage and pays for home health services like physical therapy, speech therapy, occupational therapy, skilled nursing care, and social services.

The services must be deemed medically required by your doctor, and Medicare must approve the home health organization.