Does Medicare pay for home care?

Short answer: sometimes, and far less than most families expect. Medicare pays for skilled home health care under narrow conditions. It does not pay for the long-term personal care most people mean by "home care."

What Medicare does cover

• Skilled nursing or therapy, ordered by a doctor, on an intermittent basis (not around-the-clock care)
• You must be homebound — leaving home takes considerable effort or help
• A Medicare-certified home health agency must provide it
• Aide hours are tied to the skilled need, not to how much help you actually need

What it does not cover

Long-term personal care — help with bathing, dressing, toileting, meals and supervision — is custodial care. Medicare generally does not pay for it, no matter how much you need it. This is the single biggest misunderstanding in this whole subject.

• 24-hour supervision at home
• Meal preparation and housekeeping as your only need
• Help with errands as your only need
• Help with errands as your only need

If Medicare does not pay, what does?

• Medicaid HCBS waivers — the main long-term payer, but there is a financial test and a functional test
• VA Aid and Attendance — for veterans and surviving spouses who meet the service and need tests
• Long-term care insurance — depends entirely on the policy
• Private pay — which is where most families start, and why we publish state cost data

The trap to watch for

Families often hear "Medicare will cover home health" while leaving the hospital, and later discover the aide hours stop as soon as the skilled need ends. Ask, in writing: how many aide hours are authorised, and what ends them?

Common questions

Sources

• Medicare.gov — Home health services

Related

• Cost calculator
• Medicaid eligibility screener
• What helps pay for care
• How many hours do you need
• Medicaid HCBS waivers